the_rck | Entries tagged with provigil

We're tinkering with the dosage of Provigil. The last few months, I've been napping a lot in spite of the Provigil (and in spite of the other things I'd like to be doing). I was taking 50 mg (half a tablet) once every (more or less) four hours, up to three times a day. I can't tolerate 100 mg, the smallest dose available. 75 mg might be closer to ideal, but the tablets are a narrow oblong and not amenable to quartering-- They splinter and crumble.

As an experiment, I'm now taking 50 mg every two hours, up to three times a day. It's a sneaky, sideways way of trying to get the 75 mg dosing without the impossible tablet cutting. So far, it seems to be working. The time between the first and the second dose is hard. I drag and want desperately to go back to bed. That's the time when I'm getting Cordelia ready for school, though, so I soldier through. The second dose, about nine o'clock, really seems to help-- I've been awake the last three days without naps. I even managed to watch some Netflix DVDs that I'd been putting off (in spite of wanting to see them).

Next time I see my psychiatrist, I may ask her about taking a fourth dose of Provigil. I'm usually thoroughly awake after about three o'clock without medication, but I've got time now, in the early afternoon, when I'd still like a nap. If I can get to where I'm awake then, I'll have my days back.

Last night's swim lesson went pretty well. Delia was one of two students, so each kid had an instructor's full attention. I have no idea why so many kids aren't showing up. I think there were eight kids at the first class, and I know there were four at the second. Last night was the third session.

Delia actually put her face in the water once, very briefly. She says it's something she won't do regularly until she's grown up, but she agreed that she might do it again next session as long as we only expect it once and briefly. She works so hard at keeping her head out of the water that she can't really practice kicking or arm movements.

Scott bought a bread machine on E-bay. We've made two loaves so far, both tasty. Scott's trying to get Delia interested in making bread. So far, he's had mixed success with that. She's kind of interested in helping add ingredients, but getting bread takes longer than she has patience for.

My back is still unhappy. Thursday and Friday of last week were awful, and the weekend was only marginally better. Since then, I'm mostly having trouble in the mornings and when I'm in bed.

( Boring details )

I wish my headaches came with easy signals so that I'd know what's causing them. Maybe hoisting different colored banners-- Purple for lack of sleep. Gray for dehydration. Green for low blood sugar. Orange for menstrual. Blue for sinus. Black for tension. White for fever. Pink for medication side effects. Make the banners striped for combinations and add something for a pay-attention-now! alert so I know when I need to see a doctor.

As it is, I often don't figure out what the problem is until the headache is over. Headaches make me stupid and disinclined to do anything which doesn't make figuring out the problem any easier.

( Health Details )

The queen bed that was in the basement is now gone. I'm still getting queries about it, however, not as many since my announcement that it's gone got through moderation but still multiple queries. I do understand why the e-cycle list has to be moderated, but I found that part of the process frustrating and anxiety inducing.

I think we've got a taker for the glider and ottoman, too, but the person who asked first hasn't responded to schedule a pick up. I've e-mailed her to say that I'll only hold it today, that if I don't hear from her I'll move to the next person on the list. If she actually talks to me, I'm willing to wait longer than today for her to pick it up, but there needs to be communication. She didn't give me any way but her e-mail to reach her. The next person down the list gave me a phone number and specified that he could come today.

We're still in a holding pattern over the loveseats. We have transportation for them next weekend. I'm trying to see if I can find something sooner but am not holding my breath. We also still don't know for sure if the guy wants both or just one of them. We need transportation either way, so I haven't felt that it's urgent to find out. He lives close enough that two trips over isn't going to be much more than one trip.

I'm at 2614 words for my personal NaNo goal. That puts me way behind since I was hoping for a thousand words a day. Maybe this weekend will be better. Most likely, though, I'll focus on the

livelongnmarry fic. I got responses from some of the beta readers. They all liked it. They all agreed that there's something not quite right there. They all disagreed about what the problem is. The disagreement tells me that, while there is something remaining to be fixed, it's not something obvious. I suspect that it's multiple things, any one of which could be ignored but which interact in a not so obvious way.

I did realize, from one set of beta comments, how much fandom conventions and fanon have shifted since I started reading and writing Weiss Kreuz. I hadn't really thought about it, just kept using the conventions I was used to without noticing that many current fans don't share those expectations. I don't think the changes are a bad thing or a good thing. I'm just kind of bemused that I missed seeing it happening in spite of continuing to read the fic.

I'd hoped for Cordelia to have some playdates this weekend, but none of the possibilities have worked out. With luck, she won't drive us crazy. The sun's out, and she can play outside (though Scott has different standards for what she's allowed to do outside than I do. This creates some stress on weekends when he says no to things I'd probably allow). We do have playdates scheduled both Monday and Tuesday, both over here.

I'm feeling more normal today, my second day off the Provigil. I also feel like I could sleep for another ten hours without much problem. I'll start back with 25 mg on Monday. I'd hoped to avoid going back that far as quartering the tablet is a pain in the butt. Sadly, it makes sense to go back down as far as I can. If I have five days with no side effects at 25 mg, I'll try going up to 50 mg. I won't increase from that until I've had a couple of weeks with no side effects and have talked to the psychiatrist.

Pity feeling 'normal' for me means feeling like somebody stomped on me and like I haven't slept well for a week. I also wonder if I'd have been quite so freaked out about the e-cycle process yesterday if I'd taken the Provigil. I do think that my anxiety levels decreased somewhat while I was taking it. Impossible to know.

I'm cutting this because, while it's important documentation for me on the Provigil, it's also me whining and complaining and being hugely and unreasonably cranky. Please don't read it if you're going to judge me on it or urge me to pull myself together and do the things I need to do. You'll just make me crankier, and that's bad for my headache.

( Complications with Provigil )

Yet another thing to remember about Provigil-- It increases my alertness. It increases my psychological spoons. It does *not* increase my physical spoons. I'll feel more ready to tackle physical tasks, but my body will not feel less in pain, less shaky or less tired after I'm done.

This is important.

Mind, do not be writing physical checks that the body cannot pay.

(This message brought to me by twenty minutes of minor yardwork, mostly involving picking maple seeds out of one of the raised beds.)

ETA: Mind, also please to be remembering that, although the Provigil suppresses appetite, the body still needs to eat. Three slices of cheese, a Halloween packet of malted milk balls and seven grapes are not sufficient food for one day.

A note for future reference-- 75 mg of Provigil works *extremely* well. I not only feel more alert but also much less anxious. Weird.

My second note-- Taking it at noon may have been a mistake. I'm starting to feel tired and will probably sleep, but that also came on suddenly about twenty minutes ago.

I don't know if 100 mg will be better or too much.

So far, the Provigil seems not to be a bad thing. I'm not convinced that it's giving me much more energy, but I'm also not having any major side effects. Figuring out how it affects me has been complicated by a few things-- First, Scott being off work always means that I get less sleep than I usually do. Second, my menstrual cycle has been doing weird things the last two weeks, starting well before the first dose of Provigil. Last, I've been running around a lot and experiencing a lot of stress related to decision making, impending deadlines, unexpected lack of internet and so on.

That means that I'd expect headaches every day and cramps and IBS flaring and trouble sleeping even without the Provigil. It's possible that some of it is related to the Provigil. I can't tell. It's also possible that none of it is. From what the psychiatrist said, the 25 mg. at which I started is a fairly minute dose. Given that starting there required quartering an oblong tablet with no scoring, I don't think the manufacturer expects many people to be taking less that 100 mg. I took 25 mg. for four days and have taken 50 mg. for two days with two more days to go.

After that, I have to decide if it's worth pursuing the medication. Three tablets was $27. Scott thinks his insurance might cover it. If that insurance will (and I'm not holding my breath), I think it's worth continuing on. If that insurance won't, I'm not at all sure.

I can't tell, after all, how tired I'd be without the Provigil. Yesterday is generally not a good measure for how I can expect to feel today, so comparing the last six days to the week before that or the week before that doesn't help. I'm exhausted and want to nap in spite of having taken 50 mg. of stimulant (plus my morning cup of coffee) three and a half hours ago. That might mean the medication makes me tired. That might mean it does nothing to help my fatigue. That might mean that, without the Provigil, I'd be face down on my keyboard. I have no way of knowing.

This is why it took me three months to be completely sure that Lyrica was evil and very bad for me. I needed that long to be sure that it was the Lyrica and not other life variables.

I think it's going to be worthwhile to see if we can persuade Scott's insurance to pay for the medication.

My prescription insurer has denied coverage for the anti-fatigue prescription the psychiatrist wrote me. She warned that that might happen since the medication is expensive and this is an off-label use for it. FDA approved uses are for narcolepsy, sleep apnea and shift change fatigue. I think the doctor also mentioned fatigue associated with chemotherapy as either a common use or an FDA approved use.

Scott and I are going to go out of pocket about $25 to get three tablets (I'll be quartering the first one and halving the other two) so that we can see how I respond to low doses. If I have awful side effects, there's no point in pursuing an appeal or going out of pocket or trying to make the prescription coverage through Scott's job pay instead of my coverage from the University. (While Scott's health insurance pays the primary coverage for me without complaint, the dental and prescription coverage have routinely denied that I'm eligible for primary coverage even though they're supposed to be primary.)

I'm torn now. I really hope that the Provigil helps, but I don't know if I want to pay a couple hundred plus dollars a month for a medication. I suppose it depends on if it makes me feel better and by how much. If it's just a little better, we can't afford it. If it's a lot, we'll have to consider carefully. Two hundred dollars is a lot when we start looking at the discretionary parts of our budget. We could certainly do it. It wouldn't be a lot of fun, but we could do it.

The psychiatrist did say that, if the test run of Provigil helps my fatigue, we'll have a better case for an appeal and also might consider some other stimulant, something like Ritalin. She isn't enthusiastic about Ritalin because of the 'harsh' side effects, but it's a lot cheaper.

Of course, if the Provigil doesn't help, this is all moot. I just would like something to help.

Best laid plans and all that. I suspect that's going to be my feeling about today.

My original plan was to drop Cordelia at school and then take the bus to Kroger to fill a prescription and to pick up a few things we're out of. None of it is really urgent. I can't start the new medication until Saturday or Sunday (Scott needs to be home), and we can survive a day without margarine. It's just that this morning was the best time to go-- This afternoon runs into both Cordelia being grounded and the cleaning lady's scheduled arrival. Tomorrow morning might be possible, but it would be rushed and anxiety because I need to be at the school two hours after I drop Cordelia off in the morning instead of the normal three (which would limit any groceries to things that don't need refrigeration). Tomorrow afternoon is very possible but eliminates the possibility of a playdate for Cordelia.

I'm not going this morning because I'm sick. The details would be TMI. The main factor is not wanting to spend very long out and about. I'm even having a neighbor walk Cordelia to school so as not to be out for that fifteen minutes. Past experience suggests that I'll be fine in an hour or three. If I wanted to be paranoid or superstitious, I'd say that this is my body reminding me that all of my plans depend on it cooperating.

The new medication is Provigil. I'm trying it for fatigue. The psychiatrist warned me that, because using it for anything but narcolepsy or sleep apnea is off-label, my insurance may not pay for it. I *think* my insurance will, just with a high co-pay, but I don't know yet. I did check, and it needs prior authorization, so I called her office to ask her to call that in to the insurance company.

We're starting at a very low dose-- 25 mg. That's going to require quartering the pills because the smallest pill is 100 mg. Fortunately, I have a pill cutter. The psychiatrist said that 25 mg. is a smaller starting dose than is common but that she wants to start very low because I have such a history of medication reactions and because some people find stimulants anxiety inducing. She's afraid that giving me more energy will just increase my hyper-vigilant state. I'm not so worried about the hyper-vigilance. My impression of my thought processes is that the hyper-vigilance is fed by my perception that I need extra warning of danger because my body doesn't work right and because my responses tend to be delayed (by fatigue and by some other processing issues).

Even if Provigil makes the anxiety worse, that won't permanently take it off the table as an option. It will just mean that we have to try to address the anxiety first and that we'll be waiting another year until Cordelia's in school all day.

The timing on trying the Provigil is good. Scott's on vacation next week, so he can be around to take care of Cordelia if I have a bad reaction and to watch for reactions that I can't perceive from the inside.

Anybody out there know anything about a medication called Modafinil a.k.a. Provigil? I'm doing the standard web searching-- the NIH website, the manufacturer website and so on, but I'm curious about anything any of you know from personal experience.

My psychiatrist has suggested the medication as a possible treatment for my fatigue. At this point, we're still in thinking stages. We won't try anything until September at the earliest, and we be starting at a very, very small dose as the stuff apparently has the potential to increase anxiety. My doctor simply wants to give me time to think about the medication and to research it so that I'm making an informed decision.

If I do decide to try this medication, I'll probably have a please-drink-my-booze party later this summer. This med's not something compatible with alcohol, so I wouldn't be drinking once on it, and Scott won't touch the stuff. No point having it in the house then. Pity I invested a few months ago in a few bottles, mostly sweet schnapps, meant to last a few years.