Lowell

Thanks, TF- "The newer stuff", by my observation and research, is not all it's cracked up to be- and you may have overlooked where I mention that I'm taking doxepin for the depression, which has the added benefit of being used as an antianxiety antidepressant as well, just like the SSRI's which supposedly work for GAD and PD. I have heard, and experienced, that some of the SSRI's cause emotional "flatness" and "blunting", so I'm not so sure I'd want to be taken care of by a nurse that couldn't feel appropriate emotions, like concern. I took Lexapro for one night with this last depressive episode, and I woke up according to the pattern, and noticed that I just had no emotions. Give me the weight gain and constipation that go with the older ones any day. I just hope the BON sees it that way too. Part of what I'm looking to find out is what Boards of Nursing do with insulin-dependent diabetic nurses and nurses with seizure disorder. And it's "only" 22 years. Sorry. And the worst mistake I've ever made (by no means a big one) was because I doubted my first instinct.

I'm in a situation that's got me really nervous- I'm even nervous about posting here! J Within the past year, I moved from one state to another, and applied for compact licensure in the new state. Now that I've completed my application for compact licensure in the new state, I was asked to appear before the BON personally and I think it's because: About twenty years ago I was diagnosed as having Generalized Anxiety Disorder/Panic Disorder. Since the SSRI's weren't even on the market then, benzo's and beta-blockers were the treatment of choice. I was prescribed Xanax 1 mg QID, and Inderal LA 120mg in the morning. About two years into that treatment I changed to an equivalent dose of Klonopin (6mg total), just for convenience in dosing (I could take it all at bedtime), and my internist changed the beta-blocker to Atenolol. Within a couple of years I wasn't having to see a psychiatrist any more, so my internist just took over prescribing the Klonopin and Atenolol, and this went on for several years. Then in 1999, the medical director of the mental health HMO I was under at the time demanded that I go see an "addictionologist" (I don't even know if he was board certified) to get off the Klonopin. I went along with everything this doctor tried to do, except that as I was taking less and less Klonopin, I found that I was having difficulty getting to sleep. When I called the "addictionologist" about this, all he had to say is that it would be like that for up to a year. To me that was like, "tough bananas, buddy", because he didn't seem to care at all that I was having trouble sleeping. My own perception was, and still is, that I am more impaired by anxiety, insomnia, and depression than by the benzo, so I just went to a different psychiatrist, someone that I had known for years and who had pretty much impeccable credentials, and he said "If it's not broke, don't fix it". My internist, who also has impeccable credentials, agreed entirely, and actually verbalized the same thing-"if it's not broke, don't fix it". So I went back on the Klonopin at the same dose. My marriage eventually crashed, but not because of that, and then my ex relocated my son 1500 miles away from where I had lived for 27 years, and I followed as soon as I could, because I knew my son needed me to be closer to him than that and have a more "normal" relationship with him from that. (My son's teacher told me in sort of a subtle way that this was exactly what my son needed, because he had been having measurable signs of emotional distress from being so far away from me, and these signs pretty much disappeared after I was here for about a month.) With about a month after I arrived here in the new state, I had a really bad stress reaction, with insomnia, anxiety, and depression. I think having had a stress reaction after spending a year in court over my son's relocation, losing that, and then having moved 1500 miles- I think a stress reaction under those circumstances is understandable, and I had known full well that moving to this new state would eventuate in a tapering and withdrawal of the Klonopin. But during the time I lived in the "former" state, I worked with that state's Department of Health in the Developmental Disablities Division, and the employer knew full well that I was taking benzo's, and there was ready access to lots of benzo's, for temporal lobe siezure, behavior, and spasticity. I also worked at the state's largest maximum security prison, and those people knew that I was taking benzo's and didn't have a problem with it, even though in that setting I was exposed to some pretty incredible amounts of controlled substances. Signing all that stuff out really got old fast, but I was never even tempted to divert. So I began therapy for the depression and anxiety, and am now taking 300mg of doxepin every night, and I have begun the taper of the benzo, and am now at about half (3 -1/2 mg qhs) of the original dose. I'm sleeping ok, but still a little bit depressed, and having some inappropriate anxiety. This morning I saw the psychiatrist who is both prescribing the doxepin and monitoring the withdrawal from the Klonopin (and actually increasing my "inventory" of Klonopin because of the downward titration of the dose requiring different dosages of the pills), and he said that he had sought legal advice about whether or not he was required to update the BON on my status, apparently because he doesn't want to incur liability if I'm impaired. I should point out that this psychiatrist has already made one report to the BON about three months ago, regarding my status then, at the BON's request. It was in apparent response to that report that the BON wanted me to make a personal appearance regarding my "competency and fitness to practice", based on the information that the psychiatrist supplied to them, which he had shared with me before he sent it. So, in order to be honest with the BON in regards to the health questions they asked on the compact licensure application, I told them that I had a history of Generalized Anxiety Disorder/Panic Disorder for which I was being treated with benzo's, I had recently had a major depressive episode for which I was being treated with doxepin (good for sleep, good for anxiety, worked in the past), and that the taper of the Klonopin was in progress. I guess I'm just really anxious over this appearance before the BON and whether or not they will give me a license just because I have had a history of being treated with benzo's. I never increased the dose, never cheated, never engaged in "seeking" behaviors, never diverted, never wrote my own scripts, none of that. It was all in accordance with a valid prescription from an internist with very good credentials, and a psychiatrist with very good credentials. And I never went to work "impaired" by the Klonopin, because I took it all at bedtime. Even when I was called in to do a night shift after having taken the Klonopin, I found that a little extra coffee had me wide awake and paying attention to what I was doing. So I guess my question is, should I even be nervous about this appearance before the BON? If I put myself in their place, having to decide whether a guy who has just been through a nasty depression and some pretty stressful experiences, and has been taking benzo's for twenty years- I guess I would want to meet this guy personally too, just to be on the safe side. Waiting six more weeks is a drag, but I can understand it. I know that there are people that are diverting morphine and shooting it up in the bathroom, people who come to work drunk, and so forth, but nothing like that has ever happened with me. I won't even dwell on that. I think my situation is more like an insulin-dependent diabetic nurse, or a nurse with a seizure disorder. So maybe I'm just overreacting to the psychiatrist raising the question of whether or not he needs to give updated information to the BON, apparently to cover himself for liability. Of course I have an anxiety disorder, so I might be inclined to overreact anxiously, but I'm really having trouble getting this in perspective. I've never gone to work impaired, and I've never diverted. I would imagine that, besides nurses that unfortunately do go to work impaired, and divert, that there are nurses with insulin-dependent diabetes and seizure disorder that go to work every day. I think my issue with benzo's is really small potatoes compared to that, but, since I've gotten used to bad things happening to me (my marriage crashing and my ex relocating my son), like all good anxiety neurotics do, I have a negative and anxious anticipation of what will happen with my licensure too, and I hope you all can help me place this in context and help me get some perspective. I mean, how does this stack up against nurses who take Xanax, or insulin-dependent nurses, or nurses with seizure disorder? Thanks.