Embarrassing Incident/Klonopin?

JentheRN05, RN · Dec 18, 2005

Well.....not sure what to say. I think I would find a doctor that would do an echo on you. It very well could be anxiety, I have anxiety tendancies myself, but I don't exactly get chest pain with it. But I have a family friend that DOES have chest pain with anxiety. My anxiety is the kind where I start to sweat, my pulse races, and all I can think of is getting out of here! (or for some strange reason, going home.... and I can be HOME at the time!)

But I also question the manner of how they approached confidential information at the nurses station! That was uncalled for, and I would be mortified as well.

Heck, just a couple of days ago I had my 3 month eval, my manager had tons of nice things to say, as did my coworkers. But one thing they said that was negative was that I seem to 'walk off the elevator anxious'. Like I said I have anxiety problems myself. I self admit it. Well that very night (I was already sick with a pretty bad cold) I was at work and I had some severe anxiety. For no apparent reason (realized later it was a side effect of an antidepressant I recently restarted). Anyway - I emailed my manager to tell her I saw what others were saying in myself the previous night. That I realized it was my medicine, and that I wouldn't be able to change back right away to one that doesn't cause this side effect (insurance problems). So asked if it was a no-no to take xanax while at work, explained how I had had this problem before during nursing school and I ended up taking xanax at clinicals and it wasn't a problem. Also asked a few other questions not relavent to this specific problem (just xmas stuff) and when my manager replied the ONLY thing she replied to was my question about the xanax. Her response was, I would have to check with the employee health nurse because she cannot advise me on this.

So - I know most people would just take it and not say anything, but sometimes I'm too honest for my own good. I don't take my lortab at work because I KNOW it would be frowned upon, even though I function absolutely fine, if not better taking it (because the pain isn't so bad). But stupid me brought up my xanax. Now I worry that I will be looked at differently at work because of this. Heck, I'm even concerned that I could lose my job because of it. I mean playing senerios in my head like, what if I make a med error, and realize I have been taking xanax, blame it on that and then fire me because of it.

But in all reality sake, if I am prescribed it, I am able to take it. It's a fact. If I wanted to, I could take my lortab at work, just couldn't tell anyone that I did. But still I know that would definately be crossing the line.

LOL since we're on this topic, anyone have any advice on whether or not its actually okay to take xanax at work?

I don't have any idea about Klonapin, only thing I know is I have had patients in the past who take it to sleep.

I would suggest taking it on a day off to see how it affects you, maybe a few times before you go to work with it.

calicamper · Dec 18, 2005

Thank you JentheRN05,

I really appreciated your post because it seemed like you could kind of relate. Yeah, I don't know if they should give RNs in the unit special confidentiality tx. Usually when we have patients, there are 4-5 nurses at the nurses station and we huddle and give report on all 30 pts on our side of the ER. I'm inclined to say that our unit's nurses shouldn't get special tx. On the otherhand, maybe it would be better if they just kept one or two nurses informed about us pts.

If the chest pain persists, I guess I'll try to go more the medical route again. It's just embarrassing to be pursuing medical reasons when the family practice resident decided it was anxiety. (In the ED, there was no mention of anxiety....I read my own chart).

I understand your concerns now that you brought up the xanax at work. I think you're right that since it's been prescribed for you, then you are allowed to take it. I haven't felt particularly anxious at work since I've been working there 1.5 months. Who knows, though, maybe it would be smoother sailing if I was on a benzo at work? Someone suggested to me that maybe what happened the other day was just a bunch of anxiety that I had hidden away coming out all at once. But I just don't know if it's a good idea for me. I don't know that it's necessary. Everyone is anxious when they first start a job. I'm very scared of making a med error, either now, or if I were on a benzo. There are other drugs for anxiety/depression (the SSRIs), but those haven't worked for me. So it has surprised me that the doctor relegated my chest pain to psychiatric anxiety and wants me to have a Pdoc put me on klonopin. thanks for telling me that your friend does have chest pain with her anxiety. It's reassuring to hear a support of the anxiety theory for the pain.

hbncns35 · Dec 18, 2005

OK - Just have to intervene or interject or at least give my 2 cents---

If you have to take something that enables you to do your job, regardless of what it is, then that is what you have to do.

Giving yourself a trial period to see how you react on the med is generally a good idea. If you are prescribed something for whatever your problem is then you have the right to take it. Only if your doc tells you that you cannot work is when you must make the decision to take the time off until you are well enough to work. Safety for yourself an others around you is the focus.

As far as I am aware, Klonipin works differently in diff doses with different types of people. Some get sleepy others don't. It is adviseable to keep employee health aware of your medications as they may change and have different side effects that way in case of an incident you have yourself covered at least with them.

It is unfortunate that you had to get care in your own ER but then again you have leverage in the confidentiality area if anyone gets out of line. After people see that you are OK and functioning they just go on with their own responsibilites and accept that you can do the job. Only when you present with problems over time do people make you a topic of their conversations. Reading into other's thoughts are a mere waste of time and just clutter your own thoughts about yourself. I worked in a position where I had to tell them that I had experienced problems with depression because of a conflict with my disability and that I was taking a med for it. A couple of weeks later my manager questioned me because I made a minor mistake and she concluded I was having problems and encouraged me to call the employee line. It was a mistake like anyone else could have made but because I had disclosed she made a point of bringing it up, so I had to reassure her that it was not because of that but just because I made a mistake. Well I continued to improve and she never mentioned it again.

Sometimes you just have to put up with a little nonsense because people just don't have all the facts. It takes reminding and reinforcing that you are no different than anyone else and you can contribute like anyone else. It's usually a reflection of them and not you. Eventually once you stand your ground a few times they leave you alone. Don't let the small talk get to you. Who knows when one of them may have a problem of their own. People just want to see you doing better - That's usually why they "talk"

Don't let it prevent you from getting back in there. You almost have to put blinders on and do your own thing. Eventually things get back into balance once they realize you aren't going anywhere or bothered by them. It's one of those "Put up or shut up" situations. Good Luck and let us know how you are doing and one other thing - Shame on any doctor who sees you have a Psych dx and says you're just imaging your pain. Persist on them checking out all physical area's as well as considering emotional ones. It is true that emotional issues influence physical ones but that is not just a quick way to rule something out. It's just like all the woman experiencing MI's and told they were imagining it because their symptoms were not reflecting a traditional MI. Now docs are more aware that women exp. it differently.

You are going to have to be more proactive if you want to pursue a physical dx. Persistence pays in order to rule everything out. Don't let anyone convince you its just Psyche until you check all areas out.

Heather:uhoh21:

RN1263 · Dec 18, 2005

i'm so glad i came across this post today!!! i just finished my first semester of r.n. school and i applied for a job at an e.r. as a tech (they'll do a drug screen)

but, i've been miserable lately, because i went off my ssri and klonopin 4 mos. ago....because i was scared of a drug screen test. i made a decision today even before reading your post that my sanity is worth more than some embarrasement....(i have anxiety)

i use to work in an e.r., so i know i can do the work, but i have to control this anxiety w/ meds.....PERIOD!!!....so i hope your right, that you can take klonopin w/ a script??

i don't have panic attacks, but i'm stressed and irritable as hell!!!!

good luck to you....

student4ever · Dec 18, 2005

I was mortified earlier this week. I work in an ED and during this story, keep in mind that I am a 25 year old healthy-looking female. I have taken lamictal for depression for 4 years and have not had problems with depression. I have been happy as a clam. I also have a prescription for ativan, which I had not taken for 4 months. When I took it, it was because I had obsessive thoughts about things my dad had said to me (he's very heavy handed) and I was up for hours at night regurgitating these thoughts in my head. The ativan helped me to sleep.
Well, the other day I was at work and kind of felt odd, and I purposefully did not drink the one mountain dew that I normally drink at work. Later during the shift, I felt a little odder. When I got home, my heart was beating rather fast, but I did not take my pulse, and I fell asleep. When I woke up in the morning, I took my pulse and it was 100-110. I decided to push fluids, wondering if I might be dehydrated. I went to work. My chest started hurting that morning before I headed to work at 2 pm, when my shift starts, but I didn't tell anyone. Then, I was just standing there at work a couple hours into my shift and I could feel in the snap of a finger, that my heart had kicked up its ticking by 100 notches. Then I took my pulse and it was 145. The charge nurse was nearby and took my vitals. My blood pressure was 140/85, when it's normally 100/60 and pulse was 137 (pulse is normally 88). So charge nurse said that I needed to be admitted and get a stat ekg. So there I was admitted in my own ED where I work (can we say mortifying--esp. with a psych hx?). I told them that I take the lamictal for depression and that I have ativan, but haven't taken it for four months. They put me on the monitor, did a portable chest x-ray. Did an ekg (which looked like sinus tach, but they didn't rule out stable svt [with a foci really close to the sinus node]). They gave me 3 bags of NS, even though I had no reason to be dehydrated. They gave me an aspirin and nitro paste. Then they did blood work and found a positive d-dimer, which means you might have a PE. So then they took me for a spiral chest CT with contrast. I got quite anxious about the idea of a PE and waited to be offered ativan [felt weird asking for it....didn't want to be thought of as a psych pt by the nurses I work with]. The nurse came over and ask me nicely "how much do you usually take." I was so embarrassed because I hadn't been taking ativan for four months and had told her that previously. The CT came back negative for PE. They finally gave me metoprolol or labetol, which slowed down my heart and I left the ED after 8.5 hours with a heart rate of about 100-105.
I didn't go to work the next day and my chest still kind of hurt.
I went to work the next day and my chest still kind of hurt. But I was working. Well, at one point I had been standing for a while near the nurses station and suddenly my chest felt stabbing pain and I started sweating a little and put my hand on my chest. Well, the nurse nearby looked at me and sweetly said in her normal tone of voice (i.e. not a whisper) "do you have any ativan?" I said "no... IT'S not anxiety." However, I was just mortified that she'd say that at the nurses station (how could she say it out loud like that?). She told me she was sorry later and that she thought that the thing she had asked me to do immediately prior to my chest pain had made me anxious [which it had nothing to do with it]. So she said she had felt like she caused it. So...I'm thinking....she thinks I have an anxiety disorder.
So I go find myself a family practice doctor the next day to see, who happens to be a resident and she does what I perceive to be a very unthorough exam. [i mean...I would at least get a follow up EKG or set of cardiac enzymes if I had a pt with chest pain]. She left for a while, probably talking with her attending and came back and said she thought it was anxiety. She said that I should probably get on klonopin. So I said, why don't you prescribe that? And she said she didn't feel comfortable prescribing it. Well, later I wondered if she was just nervous about prescribing a psych drug if the problem wasn't a psych one. She also suggested an antacid, which was probably a good idea. I've never had a problem with acid reflux before, but it's a good idea to try. It didn't help. I took 4 mylanta yesterday and it didn't help. I took two this morning while we were hiking, and it still didn't help. Today I went hiking with some friends and felt more chest pain 2/10. It was a fast paced 7 mile hike. In terms of anxiety, an example of anxiety more typical for me would have been an incident that happened last night. I was at a party and someone showed me that someone else was crumpled on the floor. My heart rate increased. I took some deep breaths. Walked over. Checked responsiveness. The woman was reponsive and there was a nurse at her side talking to her (and several other people). Once it was okay, I walked away and my heart slowed right down in 3-4 minutes. And during that whold incident, my heart did not increase near 140 beats a minute.
So...my question is.....fine.....I suppose I *should* trust the doc and treat this as a psych problem. Obviously starting a job in an ER is anxiety provoking, as is being away from my family for the holidays for the first time. Given that I'm so young, it would be odd to have something else major going on with my heart.
But klonopin during the day? Can people work on klonopin? The doctor said that lots of people work on klonopin. I'm not an expert, so I thought maybe some of you would have thoughts on this. If klonopin will prevent another incident of 140 bpm heart rate and quell the recent chest pain....fine....but I've never made a medication error before or done anything unfortunate, and I'm worred that taking a benzo at work might make it easier to make a mistake?
As for the ativan that I hadn't touched in four months, well, I am so mortified that all the nurses know I have ativan and how they might think of me that I have been taking it to help me fall asleep at night the last two nights or else I keep thinking about the nurses' station for hours (I hadn't taken it for 4 months).
As for the job. I love the job. I love working in the ED. I know I have what it takes to work there. one piece of advice someone gave me yesterday is that I absolutely must not mind-read what other nurses are thinking about me now that they know what is supposed to be confidential information about me [which was shared at report and through word of mouth all around the ED]. My supervisor was even at the nursing station when the nurse asked me if I had any ativan (mortifying, I say).
Any constructive feedback would be greatly appreciated.

Please don't be so embarrassed/anxious about this incident!! There are so many people on "psych" meds these days, and that doesn't mean they are "crazy!" And don't be too upset about the ativan thing... it's not uncommon to get anxious about things, or to have a hard time calming down at times! We give ativan to a variety of "types" of patients, many of whom are NOT psych patients in our ED. Its' always wierd to have co-workers know about your health issues, but the point is, you needed care, and you recieved it. You still need to be following up with a doc who will help you continue treatment until you find the true cause of your chest pain, whether it be anxiety or a cardiac problem. Best of luck to you!

RENAISSANCE RN · Dec 18, 2005

I can commiserate.. I think I would feel the same way....

As far as the heart is concerned, did anyone at least take a CBC to check for anemia, or Thyroid panel, and Echo ? I hate when people see one dx and label people as nuts.

Aren't as medical professions and human beings " most importantly " allowed to get better.

Take care and be persistant with your health.

Trauma Columnist · Dec 18, 2005

Since you are 25 y/o and healthy - you need a thorough physical plus labs and maybe an echo. Don't let them label you too soon. Taking meds (whatever they are for) are no one's business.

Long Term Care Columnist / Guide · Dec 18, 2005

I'm so glad this thread is here..........I've been having some pretty nasty anxiety issues of late myself, and it's been bad enough that I've considered taking a half-dose of Ativan during the day in addition to my regular 1 mg. dose at night (I take it for sleep). But I'm always afraid it will affect me adversely by slowing me down or making me sleepy, and THEN if I make a mistake I'll be in real trouble with benzo in my system, so I just 'gut it out'.

Naturally, one can only do this for so long, and just last week I finally had a meltdown in my manager's office......I'm burned out, for one thing, and now I can't even imagine being able to carry on in my current job because I'm so fragile emotionally. I hate the idea of having to take a pill in order to be able to perform my job, but then, I've been on antidepressants for years and don't have a problem with that.....it's just that there's such a stigma attached to the anxiety disorders, and now that the entire management knows of my 'deficiencies', my career is stalled, and I can't make even a lateral move in the organization now.

I'm not telling you all this because I need sympathy or advice, it's just to share with the OP and others that they're not alone in this. I don't know what the answer is......but I do know this problem is more widespread than any of us probably knows, and that we not only need to find out why so many nurses suffer from anxiety and depression, but how to effect changes in the workplace that will enable us to stay in the profession and do our best work.

Sorry, this is a bit off-topic........I wish the OP good luck in finding out the cause of her symptoms and getting the right treatment for them.:)

leslie :-D · Dec 19, 2005

i firmly believe that any nurse that has a mental health disorder is EXTREMELY stigmatized by the nsg profession.

last year my psychiatrist prescribed to me, seroquel 300 mg po qhs in hopes of suppressing flashbacks i had been receiving from early childhood trauma. the starting dose is 25 mg po bid. i had an adverse reaction to the seroquel and one day at work, i became stuporous. i was reported to appear impaired w/slurred speech and unsteady gait. my DON had known about me being on this med. i was suspending, pending the outcome of an investigation from the dept of public health. the day i was suspended, i made an emergency appt w/my psychiatrist, demanding he dc this med. dph reported this incident to the bon and i had to respond to this one allegation. my psychiatrist as well as my therapist both wrote letters to accompany my response.

just recently, i received a letter from the bon to surrender my license.

in the cover letter, dph had added several more allegations against me including morphine tampering!!!! i was outraged!!!! they gave me 15 days to surrender my license or if i didn't, they will prosecute which would proceed to an adjudicatory hearing. i absolutely refused to surrender my license. yes, i can see why anyone would be concerned about a nurse being impaired. yet i got it dc'd immediately- i had trusted his judgement even though my therapist was totally against me taking the seroquel. she felt he was treating me as if i had a psychosis. but never in a million years would i divert, tamper or take anything away from a patient and that's where my indignence lies. yet i do believe that because i was on such a high dose of seroquel, i was an easy target, vulnerable and discriminated against for having a mental illness (complex ptsd).

i share this with you all because i am experiencing the outrageous bias against those w/mental disorders. i will always be accountable in where i err, but this nurse will never surrender her license w/o kicking, screaming and fighting for all the other things they've accused me of. i already have an attorney for when he's needed. just be careful about what you reveal and who you reveal it to....i know that in most places, your employer needs to know what meds you're on. but the stigma and prejudice will always remain from the majority.

marla, if you're anxiety levels are that high (and i know they are), there's nothing wrong w/visiting your doctor to write a different script for the ativan; or if you're not already, trying one of the ssri's which are known for their anti-anxiety effects.

leslie

calicamper · Dec 19, 2005

Hi, I'm the original poster,

Thanks all for writing to me. I know my post was really long to read. I really appreciate your commiseration. Also, thank you for your support for getting more physical health care if necessary and for commiserating with me that sometimes if you have a hx of pyche, the doctors can overdwell on it (although they certainly did not at the ED that night). I will keep you posted. I'm going to just keep my cool tomorrow and act like nothing happened, nothing's wrong, and not let myself think what others are thinking. They can talk all they want....while I'm getting my job done. (FYI...it is a nice group of people...it's just embarrassing that they know my hx).

Thunderwolf, MSN, RN · Dec 19, 2005

So much discussed on so few pages...whew!

Myself, I have a history of PTSD. During that time, I was on Seroquel for the flashbacks, as well as being on Klonopin. Common practice. Sorry, Leslie for all that you are going through.

You are most correct in that discrimination exists for nurses who have mental/emotional health issues, even amongst psych and nonpsych nurses. It is one of those last barriers that need to be overcome. And anxiety can be very crippling.

This whole thread does bring up the issue of "inform your employer or not" regarding your use of medications. It is a double edge sword as well as can place one in a double bind. However, I believe that meds, for whatever use, needs to be documented somewhere in your employee record. It is honest. Working closely with your physician in conjunction with your employee clinic is often the way to go.

I have had a couple episodes of Atrial Fib since 1998, stress related, needing to be on a Beta blocker from time to time. Past stress (PTSD) and current stress have often kicked it off or have kicked off my PTSD sxs. It is amazing how the body and mind work in conjunction. The body never forgets, neither does the mind. However, we do have a choice to listen to ourself. When the body groans or the mind becomes tested, it is our cue to begin better coping and to make positive changes. I just had a stress echo myself recently and passed with flying colors.

Currently, the only medication I take now is Toprol XL. When I have an episode of Atrial Fib, my heart rate easily jacks from my usual resting 60-70 to 160-170 in a matter of seconds. My last episode was in March 2005. I take no other meds than the Toprol XL.

My PTSD has been in check since 2003. No meds required for that since that time. But, during the 5 year period of PTSD and Depression (1998-2003), I was on 5 different meds, in counseling, and hospitalized twice. Not pretty. Wasn't fun. Don't plan to return back there. So, you see...I do understand and empathize.

However, geting back to the OP, I also recommend some additional work up.

Thyroid studies, yes. Echo/stress echo, yes. Benzos? or another type med?, even beta blockers are used for anxiety. So, please don't worry or despair. Be careful who you speak to however at work. Your personal business is your own. There will always be someone who can twist your personal business out of context...unintentionally or intentionally. So, be mindful of that. Discrimination does exist as Leslie points out.

Follow up with your physician, discuss further tests, and the different choices of meds that may be helpful. Your future remains bright. Do not forget that.

Wish you the best.