Correspondence with Dr. Atkins

RE: Thinking about Lamictal

 —– Message —–
From: TERRY,ELIZABETH G
Sent: 10/15/2009 5:56 PM
To: Office of DAVID ALEXANDER ATKINS MD
Subject: Thinking about Lamictal

Hi Dr. Atkins. I know we have scheduled a phone appointment to discuss starting Lamictal, but I’m actually feeling like maybe I should get started right away.

As it turns out, I have been experiencing some deep depression as well as inability to focus/agitation since our appointment on Tuesday. I feel weepy. Don’t know if it was the rainy weather or shortening days, but I really feel like a need help sooner than later. And if you feel that Lamictal can help level me out and help me focus without taking away my drive and motivation, then I am willing to try it.

What do you think?

Beth Terry

To:

Elizabeth G Terry

From:

DAVID ALEXANDER ATKINS MD

Received:

10/15/2009 10:39 PM PDT

Beth,

I think this is a very reasonable plan. Keep in mind that it may well take at least 4 weeks to have a significant effect (because of the need to start at a low dosage and with gradual increasing dosage schedule. If you’re ready to start this, let me know where you would like to pick up the medication.

Dr. A

P.S.

You have a great blog!.

—– Message —–
From: TERRY,ELIZABETH G
Sent: 10/16/2009 1:20 AM
To: Office of DAVID ALEXANDER ATKINS MD
Subject: RE: Thinking about Lamictal

Thank you. (And thanks for the compliment.) I can pick it up at the main Fabiola pharmacy.

If you look at the time stamp on this email, you’ll see that it’s 1:16am, and I am wide awake. Okay, you wouldn’t know the wide awake part from the time stamp. I could take Xanax and go to sleep in about half an hour. But like I said, I’m kind of phobic about going to sleep at night (who would stay up and make sure the world keeps turning if I went to bed?) and have a mile-long list of things to do. Of course, I know I’ll just feel worse tomorrow.

*Sigh*

I tried the Kaiser insomnia online program, but I just couldn’t stick with it. Suggestion?

Beth

To:

Elizabeth G Terry

From:

DAVID ALEXANDER ATKINS MD

Received:

10/16/2009  6:17 AM PDT

Beth,

The medication (starter pack with dosing instructions) will be ready for pick up this AM. You can take the medication at any time of The day, but I’d recommend picking a consistent time of day or night.

The insomnia is a complicated matter for you as you clearly appreciate. I will be mindful of this concern with you as you respond to Lamictal or other medications/strategies you try.

Dr. A

—– Message —–
From: TERRY,ELIZABETH G
Sent: 10/29/2009 7:08 PM
To: Office of DAVID ALEXANDER ATKINS MD
Subject: Update & Refill Request

Hello, Dr. Atkins,

I just want to update you on my progress taking Lamictal, not drinking, etc.

So far so good. I have taken the Lamictal every morning as directed for 10 days and so far no rashes or anything weird. I have also refrained from any alcohol at all for the entire time. I am very motivated to have this medication work. Additionally, I have quit coffee. I feel like I was on a coffee/alcohol roller coaster.

I am still drinking black tea and hot chocolate, so there is some caffeine, and I am still having trouble sleeping without Xanax. I have taken the Xanax every night except for one since going on the Lamictal, and the one night I didn’t take it, I pulled an all-nighter at the computer.

I do need a refill of the Xanax (Fabiola Main Pharmacy). I have 1-1/2 pills left and will be taking one tonight. I would like to be off it eventually, but right now I think it keeps me from drinking instead.

I’m home all day Friday if you want to talk. 510-595-6865

Thank you!
Beth

To:

Elizabeth G Terry

From:

DAVID ALEXANDER ATKINS MD

Received:

10/29/2009 10:41 PM PDT

Beth,

That’s terrific!
I’ve refilled the Xanax which will be available for pickup tomorrow AM.

Keep me posted.

Dr. A

—– Message —–
From: TERRY,ELIZABETH G
Sent: 10/29/2009 7:11 PM
To: Office of DAVID ALEXANDER ATKINS MD
Subject: By the way…

If you like Jackson Browne, check out the interview I did with him in L.A. this weekend:

http://fakeplasticfish.com/2009/10/jackson-browne-defiant-about-bottled-water/

And also by the way, it was a weekend full of cocktail parties and happy hours, during which I discovered that pineapple juice and seltzer is almost as good as a mai tai, if I squint. 🙂 [ 02/05/2013 Ooh!  Have to remember this!]

To:

Elizabeth G Terry

From:

DAVID ALEXANDER ATKINS MD

Received:

10/29/2009 10:43 PM PDT

Beth,

You are very funny!
I look forward to reading your interview with Jackson Browne (I’m convinced my sister named her son Jackson after him)

Keep up your good work

Dr. A

—– Message —–
From: TERRY,ELIZABETH G
Sent: 11/16/2009 2:18 PM
To: Office of DAVID ALEXANDER ATKINS MD
Subject: Lamictal/Xanax

Hi Dr. Atkins. Well, so far so good. I have been on the Lamictal for 4 weeks now and no rashes or anything. My mood has been good. I do need the Xanax to wind down at night. Do you think that increasing the Lamictal will help with that? Starting tomorrow, I double the dose from 100mg to 200mg.

I have a week of Lamictal left and about two weeks of Xanax. I know it’s probably too early to refill the Xanax, but if there is any way I could sync up the two prescriptions so I can pick them up at the same time, it would be very helpful since I don’t have a car. (Although having a reason to ride my bike is always helpful for my health.)

Oh, the biggest news — no alcohol in 4 weeks.

And I’m totally off caffeine too except for chocolate. That’s a hard one.

Beth

To:

Elizabeth G Terry

From:

DAVID ALEXANDER ATKINS MD

Received:

11/16/2009  6:02 PM PST

Elizabeth,

I’ve ordered both medications for pickup as soon as Wednesday at Fabiola 1 pharmacy.
Glad you’re mood is good, no skin problems and that you’re poised to do better off alcohol and caffeine.
I’d avoid the expresso chocolate but otherwise enjoy!

Dr. A

—– Message —–
From: TERRY,ELIZABETH G
Sent: 12/16/2009 1:35 AM
To: Office of DAVID ALEXANDER ATKINS MD
Subject: Update & ready for Xanax refill

Hi Dr. Atkins. All is well. I’m actually feeling better than I have in a very, very long time. Calmer and yet more focused and actually energetic. I didn’t realize it was possible to be calm and energetic at the same time.

Of course, it could also be that I am off the cycle of caffeine and alcohol. My husband has noticed a difference too. He says he’s enjoying being with me more these days.

Still, I am taking one Xanax each night to go to sleep. Not ready to give up that security blanket. I have 7 pills left.

Thanks!
Beth

To:

Elizabeth G Terry

From:

DAVID ALEXANDER ATKINS MD

Received:

12/16/2009 10:01 AM PST

Hi Beth,

I’ve reordered the medication for pickup as soon as today at Fabiola 1 pharmacy.
I’m so glad you’re feeling better.
Best wishes this holiday season,

David

—– Message —–
From: TERRY,ELIZABETH G
Sent: 2/13/2010 1:28 AM
To: Office of DAVID ALEXANDER ATKINS MD
Subject: Lamictal

Hi. Ready for an RX refill for Lamictal. Have not been taking the Xanax for sleep, so I still have plenty of that in case of anxiety. I felt like it was starting to impair cognitive function during the day and affect memory. Not good. Wondering if there is something else I can take for sleep other than a benzo. I’m actually thinking it’s a big psychological prob and maybe something like hypnotherapy would be helpful. Does Kaiser offer or refer for anything like that?

Oh, and I have not had alcohol in 122 days. I have a lot to say about that, but Kaiser is limiting the number of characters I can type.

Beth

Ooh… The instructions say I can attach up to 3 images to show my condition. Fun. Image would show me sitting in my bathrobe at the computer at 1:30 in the morning wondering once again why I can’t sleep. 🙂

To:

Elizabeth G Terry

From:

DAVID ALEXANDER ATKINS MD

Received:

2/16/2010 10:01 PM PST

Hi Beth,

Sorry for my delay in responding to your message.

I’ll re-order the lamictal. Do you pick it up or have it mailed?
I wrote in my intake note that you indicated Seroquel had not been helpful. It looks like you were prescribed this at a moderate dosage. It’s one of the more potent medications for insomnia (but carries with it significant longer term risks if taken regularly).

My understanding is that hypnotherapy is not an evidenced based medical treatment for insomnia but since hypnosis is in part a method to attain significant relaxation, it could be potentially helpful to sleep. I assume you have explored meditation/relaxation strategies in the past.

David Atkins, MD

—– Message —–
From: TERRY,ELIZABETH G
Sent: 2/17/2010 9:19 AM
To: Office of DAVID ALEXANDER ATKINS MD
Subject: RE: Lamictal

I like to pick it up from Fabiola Main pharmacy.

Seroquel made me feel like I had worms crawling under my skin.

I guess the reason I was thinking of hypnotherapy was as a way to get to the root of the mental blocks to sleep. I had 3 sessions of hypnotherapy about 20 years ago for fear of flying, and it worked amazingly well because the therapist was able to root out the source of the fear so that her hypnotic suggestions were relevant.

I was thinking maybe something like that could work for my insomnia since it seems less related to the actual state of my body and more my irrational fear of giving up my vigilant watch at night. (If I’m not awake to make sure the world continues to spin, who will do it?)

In the conscious light of day, the fear of sleep seems really stupid. Especially when I’m tired and all I want is to sleep. Anyway…

To:

Elizabeth G Terry

From:

DAVID ALEXANDER ATKINS MD

Received:

2/17/2010 10:05 PM PST

Hi Beth,

I’ve ordered the medication for pick up at Fabiola 1 pharmacy. Let me know if you’d like me to arrange an appt for you with a good psychotherapist in our department who might help you with this symptom.

-David

—– Message —–
From: TERRY,ELIZABETH G
Sent: 5/19/2010 10:58 AM
To: Office of DAVID ALEXANDER ATKINS MD
Subject: Lamictal slowing me down too much

Hi Dr. Atkins.

Back in Feb I wrote that I thought the Xanax was impairing cognitive function and memory. So I’ve been off it for over a month, and what I realized is that it’s actually the Lamictal that is doing it. Within an hour after taking the Lamictal, I feel kind of high, stupid, and lethargic. So I started taking it at night instead, but I still feel slow in the morning. (Right now, in fact. And I took it around 2am.)

I reread my emails to you. Back on 12/16 I wrote that I felt “Calmer and yet more focused and actually energetic.” I don’t know what my dosage was back then. But I am feeling anything but focused and energetic right now.

Wondering if I should cut back on the Lamictal. But worried about having mood swings if I do it.

What do you think?

To:

Elizabeth G Terry

From:

DAVID ALEXANDER ATKINS MD

Received:

5/19/2010 11:21 AM PDT

Hi Elizabeth,

Though not common, this can happen with Lamictal.
It’s worth reducing your dosage to 150 mg (3/4 tab/day).
Keep me posted.

David Atkins, MD

—– Message —–
From: TERRY,ELIZABETH G
Sent: 5/20/2010 3:47 PM
To: Office of DAVID ALEXANDER ATKINS MD
Subject: Caffeine?

Hi Dr. Atkins,

As I mentioned, I gave up both caffeine and alcohol when I went on the Lamictal because I felt like they were putting me on the mood roller coaster.

Now, I’m wondering about caffeine in light of the Lamictal lethargy but also because of this article I just read today. Would love to get your opinion:

http://www.care2.com/greenliving/reasons-to-drink-coffee.html#

(Page 2 and 3 list the “8 Reasons”)

I have no desire to get back on the coffee roller coaster, but I’m wondering if black tea would safely benefit me. I wanted to get your opinion first because of course articles like these usually don’t bother interpreting the research in any meaningful way, if the writer has actually read the study in the first place.

Just afraid to do anything that could spin me into anxiety again.

Thanks.

To:

Elizabeth G Terry

From:

DAVID ALEXANDER ATKINS MD

Received:

5/23/2010  8:53 PM PDT

Elizabeth,

I wasn’t aware of this.
Here’s an article I found confirming this info.

Http://jn.nutrition.org/cgi/content/abstract/134/3/562

Let me know how a modest amount of black tea affects you (if you decide to try it)

Best wishes,

David Atkins, MD

—– Message —–
From: TERRY,ELIZABETH G
Sent: 8/1/2010 9:21 PM
To: Office of DAVID ALEXANDER ATKINS MD
Subject: Xanax prescription

Dear Dr. Atkins:

For the last few months, I’ve been doing fine without Xanax, but recently I’ve experienced an increase in anxiety due to work issues, family issues, and an upcoming conference in New York City this weekend at which I’ll be speaking. I think Xanax would be really useful for me right now. I’m leaving for NYC on Thursday morning. Would it be possible for me to pick up the prescription no later than Wednesday morning?

Thanks,
Beth

To:

Elizabeth G Terry

From:

DAVID ALEXANDER ATKINS MD

Received:

8/2/2010  8:26 AM PDT

Hi Beth,

Of course. I’ve ordered it for pick up tomorrow at Fabiola 1.
I hope you enjoy the conference and time in NYC.

Best wishes,

David Atkins, MD

—– Message —–
From: TERRY,ELIZABETH G
Sent: 12/15/2010 11:34 AM
To: Office of DAVID ALEXANDER ATKINS MD
Subject: Need an appointment ASAP

Hi Dr. Atkins. I’m feeling more depressed and anxious than I have in a very long time. And my brain is not functioning properly. I can’t write, which is a problem since I just got a book deal and I feel like throwing up every time I think about it.

I’m losing my words and my memory.

And I started drinking because nothing else would relieve the anxiety.

My husband wants to come with me to my appointment to help since I can’t remember things.

Is there any way you can fit me in soon?

Thanks,
Beth Terry

To:

Elizabeth G Terry

From:

DAVID ALEXANDER ATKINS MD

Received:

12/15/2010 12:09 PM PST

Hi Beth,

I’m sorry to hear about your symptoms.
I can see you tomorrow morning at 8 or 8:30 AM.

Let me know if this works.

David Atkins, MD

—– Message —–
From: TERRY,ELIZABETH G
Sent: 12/21/2010 6:12 PM
To: Office of DAVID ALEXANDER ATKINS MD
Subject: Strattera so far

Hi Dr. Atkins,

The Strattera does seem to be making a difference in both my mood and cognitive function. I’ve taken 20mg for the past 3 days, and instead of upping it to 30mg tomorrow, I think I’m going to stick with 20mg for a few more days and make sure my mood doesn’t get too hyper. I feel a little bit jittery but much better than I was feeling last week.

I just put in a request to refill the resperdal and xanax. I’ve been taking 1/2 a xanax at night for the past couple of nights, down from a full tablet.

I’m also noticing decreased appetite, which is not a bad thing for me. I have less desire to mindlessly munch. I hope that effect will last.

Beth

To:

Elizabeth G Terry

From:

DAVID ALEXANDER ATKINS MD

Received:

12/23/2010  5:04 PM PST

Beth,

It sounds good. Keep me posted.
Enjoy the holidays!

David

—– Message —–
From: TERRY,ELIZABETH G
Sent: 1/1/2011 10:56 PM
To: Office of DAVID ALEXANDER ATKINS MD
Subject: Need Strattera refill

Hi Dr. Atkins. I am down to about a week’s worth of Strattera. I am taking 3 pills per day now. I think I would like to keep getting 10 mg capsules so that I can have finer control over how much I take. I don’t feel like I’m ready to go up to 40. Maybe I will never be. I really feel it when it kicks in. And it’s definitely helping.

I saw my lab results and am worried about my cholesterol. I stopped taking the Risperdal. I’m not sure I need it. I think I’m fine with just the Lamictal and Strattera. What do you think?

To:

Elizabeth G Terry

From:

DAVID ALEXANDER ATKINS MD

Received:

1/2/2011  7:39 AM PST

Hi Beth,

I’m so glad the Strattera is helping. I ordered the 10 mg pills, # 100. In the future you may want to consider taking the 25 or 40 mg pill dosage.
It’s fine to stop the Risperdal and continue with the Lamictal as well.

Happy New Year.

David Atkins, MD

—– Message —–
From: TERRY,ELIZABETH G
Sent: 1/27/2011 11:00 AM
To: Office of DAVID ALEXANDER ATKINS MD
Subject: Refill Strattera & TEDx video

Hi Dr. Atkins. I just left you a voicemail but realized I didn’t leave my Kaiser record # if you need that. Need to refill Strattera ASAP as leaving Saturday for a week. Would like to go up to 40mg capsules and hoping I can get more than one month’s worth at a time. Explanations are on the voicemail.

Also, I thought I would send you the link to my TEDx talk from November. I was nervous as all get out, but once I hit the stage, I was fine.

http://www.youtube.com/watch?v=3JXWRVrFiKs

Cheers,
Beth

To:

Elizabeth G Terry

From:

DAVID ALEXANDER ATKINS MD

Received:

1/27/2011  2:39 PM PST

Hi Beth,

Thanks for the videolink.
I’ve ordered the 40 mg cap, #100 for pick up now. (or when you can get to Fabiola 1 pharmacy)
Best wishes!

David Atkins, MD

—– Message —–
From: TERRY,ELIZABETH G
Sent: 1/28/2011 8:22 PM
To: Office of DAVID ALEXANDER ATKINS MD
Subject: RE: Refill Strattera & TEDx video

Hi. I just checked the online refill center and got the message that they have not received a refill order for the Strattera.

I have to leave tomorrow morning, but Michael reminded me that he takes 40mg Strattera, so I can take some of his with me. I won’t be back until the 7th. I’m not sure how long the pharmacy will hold a prescription before canceling it.

Anyway, not sure what happened but I’ll check again when I return.

Beth

To:

Elizabeth G Terry

From:

DAVID ALEXANDER ATKINS MD

Received:

1/28/2011  9:03 PM PST

Hi Beth,

I don’t know what the problem was. Here’s the info I have on the order. You might call the pharmacy with the order number or prescription number below. Alternatively, I can order it again.

Sorry for your this problem.

David Atkins, MD

—– Message —–
From: TERRY,ELIZABETH G
Sent: 3/6/12 09:12 AM
To: DAVID ALEXANDER ATKINS MD
Subject: Wellbutrin

Hi Dr. Atkins. The Wellbutrin alone is working amazingly well. I have been able to completely quit coffee again because the Wellbutrin makes me feel wide awake and very clear-headed, but not overly so. No signs of hypomania. I just feel like a weight has been lifted from my shoulders. I hope it lasts.

I need another refill, and before I request it, I was wondering about one thing. Is it possible for me to get more than one month’s worth at a time? I am just trying to figure out a way to reduce the number of plastic bottles I go through since they cannot be refilled by the pharmacy and can only be recycled (which, when it comes to plastic, is not very environmentally-friendly, actually.) I wish the pharmacy could just reuse my bottle for the same medication, but I believe there is a law against it. Anyway, just thought I would check, as reducing plastic, as you know, is my mission and the topic of my book.

Beth Terry

To:

Elizabeth G Terry

From:

DAVID ALEXANDER ATKINS MD

Received:

3/6/2012  6:05 PM PST

Hi Beth,

I’ve ordered a 3 month refill to be mailed to you.
I’m so glad you’re feeling better. Keep me posted when your book is released.

Dr. A

—– Message —–
From: TERRY,ELIZABETH G
Sent: 3/6/12 06:56 PM
To: DAVID ALEXANDER ATKINS MD
Subject: RE: Wellbutrin

Thank you. They will put them all in the same bottle, right?

I absolutely will let you know when the book is released. The publication date is now scheduled for May 15. Did I send you info about the book yet?

http://myplasticfreelife.com/plastic-free-how-i-kicked-the-plastic-habit-and-how-you-can-too/

Also, just a few minutes ago, I found out I was selected to give a keynote at the LOHAS Forum in Boulder this summer. It’s a conference attended by businesses trying to go green — some as large as Google and Toyota to small startups. I’m pretty excited and nervous about that. But I know I’ll be okay.

To:

Elizabeth G Terry

From:

DAVID ALEXANDER ATKINS MD

Received:

3/8/2012  3:53 PM PST

Beth,

I can’t tell you whether they sort the 3 month prescriptions into one, two or three bottles.
It’s a large highly automated system in Livermore but I’ll try to find out.

I’d love to receive info on your book.
Congratulations on being selected as a keynote speaker at the conference this summer.

Dr. A

—– Message —–
From: TERRY,ELIZABETH G
Sent: 3/9/12 10:18 AM
To: DAVID ALEXANDER ATKINS MD
Subject: RE: Wellbutrin

Thanks. After today, I have 5 days worth. Will it arrive in time?

To:

Elizabeth G Terry

From:

DAVID ALEXANDER ATKINS MD

Received:

3/9/2012 10:19 AM PST

It should. If it doesn’t call me and I’ll order a small prescription (unfortunately, another bottle)

—– Message —–
From: TERRY,ELIZABETH G
Sent: 1/10/2013 2:45 AM PST
To: DAVID ALEXANDER ATKINS MD
Subject: sobriety

Hi Dr. Atkins,

I need to let you know that I started drinking again, even though I know I’m not supposed to drink when taking Wellbutrin, and it had become unmanageable. I decided that I really needed help, so I joined AA about 3 weeks ago and have been going to meetings regularly every day.

I realize I simply can’t ever drink because it always, always goes too far eventually.

I don’t know if you think we should change my medication or not. I have a sponsor who was concerned about the Xanax. But I don’t take it often, as you can see from my record. I do fear that if I do take it, it might lower my inhibitions so that I drink again. However, knowing that, I am not likely to take it unless I am having a real anxiety attack. I guess it makes me feel secure to know it’s there and that I can take it instead of alcohol if I do have anxiety. But I’ll leave it to you to decide if it’s wise for me to have it.

Should we discuss? I’m fine with email if you are.

Beth

To:

Elizabeth G Terry

From:

DAVID ALEXANDER ATKINS MD

Received:

1/13/2013  9:15 PM PST

Hi Beth,

Sorry to hear about your recent loss of sobriety.
I’d avoid Xanax altogether.
We can discuss in person or by phone whenever you’d like.

Best wishes,

David Atkins, MD

—– Message —–
From: TERRY,ELIZABETH G
Sent: 1/14/2013 12:14 AM PST
To: DAVID ALEXANDER ATKINS MD
Subject: RE: sobriety

Hi. I’m visiting my family in Maryland right now and will be returning Tuesday evening. Do you have time to chat by phone Wednesday morning before 11am? Could we make a phone appointment?

Thanks,
Beth

To:

Elizabeth G Terry

From:

DAVID ALEXANDER ATKINS MD

Received:

1/16/2013  7:32 PM PST

Hi Beth,

I have time tomorrow morning (Thursday) at 9 AM.
My phone number is 752-7360.
If this time doesn’t work, let me know what can work for you.

Thanks,

David Atkins, MD

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