To return to this matter of medication I had stated that the switch to Ritalin from Dexedrine was unremarkable in relation to EDS. On the other hand the effect on my Cataplexy of the switch to Imipramine was largely negative, in that it was far less effective in this regard than Dexedrine with the result that my cataplectic attacks continued unabated, if not worse. The significance of this will be appreciated when I explain that the cataplectic attacks are by far the most frightening aspect of Narcolepsy and even up to now the symptom I dread most. To elaborate; a cataplexy is a reaction to any emotion - anger, amusement or some other vague, undefined emotional response - which causes all the voluntary muscles of the body to go limp, including even the eyelids, so that the narcoleptic is unable to stand or hold anything and if there is no one around or something to lean on he is in danger of falling in an uncontrolled way and seriously hurting himself, especially his or her head. On many occasions I have had attacks when there is no one around and I have had to spend the next 10 or 20 minutes desperately trying to hang on to a counter or a wall to prevent my knees from buckling or to retain my balance. In such situations the tension has at times been so great that I will develop searing headaches, causing my head to feel as if my brain was on fire. The fear in all of these situations is that of hitting my head when I fall, and although I have managed to avoid the dreaded circumstance coming to pass for most of my life, within the last 5 or 6 years I have had on two occasions fallen and struck my forehead and had to receive stitches. I should also point out that, frequently, during my cataplexy I hallucinate that I am in a situation in which my life is being threatened and I am calling for help to someone who is not really where he seems to be in my hallucination, nor is my voice making the sound which I think it is. However, as I have grown older the life-threatening situations have gradually come to be replaced though not entirely, by socially embarrassing situations, such as the fact that I may hallucinate that there is a massive crowd present when I am experiencing my cataplexy although there is no one present. On the other hand, I have had an attack while out at a public occasion and although fortunate to be in a seated position, I had an hallucination of being attacked and, as a result, kicked wildly at concerned friends who approached me to enquire as to my well-being.
Not knowing any better, I was forced to endure Imipramine (75mg daily) for the next 12-15 years until, becoming somewhat computer literate in the late 90s, I came across Stanford University’s Website Center for Narcolepsy and in particular, its brief analysis of Narcolepsy medications. In there I saw that the website described Anafranil (Clomipramine) in relation to the treatment of Cataplexy as “Very effective, mostly used in Europe”, whereas, of Imipramine, it simply stated “Anticholinergic effects”(which I gathered suggested dry mouths and blurred vision). Thereupon, I resolved that I was going to try using Anafranil instead of Imipramine and set about persuading my doctor to switch to Anafranil. No doubt with a little research of his own, he realized that there was some point to my efforts and he switched me to three x 25mg tablets of Anafranil daily. The difference in the frequency and severity of cataplectic attacks was dramatic and ever since then, I have been on Anafranil together with Ritalin. A word of caution, however, is called for in the use of Anafranil. One of the effects of this drug is to prolong the erection of the male. I am not aware that it assists in enabling an erection but I know that it retards the advent of a climax in a man and I imagine that an overdose could cause very painful and embarrassing circumstances if not worse. Indeed, I am convinced that many men in pornographic movies use Anafranil to enable them to perform in those movies. My very moderate lifestyle has never created any situation in which I was tempted to take an overdose of Anafranil.
Sunday, July 19, 2009
Saturday, July 11, 2009
Professional Life (Part 1)
Upon my return to Jamaica in 1961 my family doctor who administered the medication insisted that I go to see the head of the Neurological Department of the University Hospital but the only direction I was given was to continue with the medication(Dexedrine) I was taking, which I did. Nothing changed in respect of my medication for more than twenty years until the early eighties when the then acting head of the department looked in a text book and advised that the current medication which was being used for EDS was Ritalin (Methylphenidate) and the medication for Cataplexy was Imipramine (Tofranil). As a result my doctor, on his instructions, switched my medication to Ritalin (5 x 10 mg tablets daily) and Imipramine (3 x 25 mgs tablets daily). Quite frankly, there was hardly a noticeable difference between the effect on my EDS of Ritalin and Dexedrine and I simply continued the use of Ritalin because it was the recommended medication, and I had been hearing rumblings about the abuse of dextroamphetamine tablets especially by college students. In fact, even the “Prescribing Information” put out by the manufacturers (SK&F) contained phrases like “Amphetamines have been extensively abused", "Tolerance, extreme psychological dependence, and severe social disability have occurred", "Manifestations of chronic intoxication with amphetamines include severe dermatoses, marked insomnia, irritability, hyperactivity and personality changes.”
As I have said before, in the more than twenty years that I have used Dexedrine, literally every day, there has not been the slightest hint of any psychological dependence nor has there been any urge at all to increase the prescribed dosages of medication. Of course I am not in a position to say whether the fact that I am a narcoleptic makes me less liable to forming a dependence on amphetamines than normal persons and in fact I have heard it suggested that narcoleptics have a “paradoxical” reaction to such drugs but I cannot say with what authority such a suggestion is made. What I can say without any doubt is that I was, and still am, liable to forget to take my medication every day if I did not work out a system to ensure that I always had some spare tablets on my person in case I had forgotten to take the prescribed medication when I should.
In regard to my profession, I established private “digs” and went into private practice as a criminal defense attorney from time to time in association with other attorneys, without revealing, except in the case of close friends. I managed to make adjustments in relation to my napping practices and intake of medication so as to be able to practice in the Courts reasonably successfully. One thing that I had become aware of from I was in high school but which came home to me very sharply early in my practice was the fact of my poor memory for details and that it required that I put in twice as much work in order to master the facts and the law in each case. It also meant that where the citing of authorities were necessary in any case I could not depend upon my previously acquired knowledge of these authorities except as to the fact of their existence and I had to repeat earlier research in order to rely on it again.
In addition to my private practice I, and a number of other persons, especially lawyers, who were aware of a tremendous amount of social and economic injustice in the Jamaican society which led to exceptional civil and human rights abuses especially by the police, got together in 1968 and formed the Jamaican Council for Human Rights, dedicated to fighting against the growing civil rights abuses which were being practiced. Along with the creation of the JCHR I initiated the practiced of filing civil actions against not only against the security personnel who had committed the civil or human rights abuse but also against the state itself, on the principle that the policeman was, at the time acting as the servant or agent of the state. The JCHR has had some significant success in raising public awareness of the prevalence of civil rights abuses by the police, it has also succeeded in getting legislation introduced to curb the practice of wanton police abuses and has by its militance succeeded in preventing the exercise of capital punishment since 1983 until the date hereof. However, further elaboration of my legal practice and related matters must be reserved for another time and subject matter.
As I have said before, in the more than twenty years that I have used Dexedrine, literally every day, there has not been the slightest hint of any psychological dependence nor has there been any urge at all to increase the prescribed dosages of medication. Of course I am not in a position to say whether the fact that I am a narcoleptic makes me less liable to forming a dependence on amphetamines than normal persons and in fact I have heard it suggested that narcoleptics have a “paradoxical” reaction to such drugs but I cannot say with what authority such a suggestion is made. What I can say without any doubt is that I was, and still am, liable to forget to take my medication every day if I did not work out a system to ensure that I always had some spare tablets on my person in case I had forgotten to take the prescribed medication when I should.
In regard to my profession, I established private “digs” and went into private practice as a criminal defense attorney from time to time in association with other attorneys, without revealing, except in the case of close friends. I managed to make adjustments in relation to my napping practices and intake of medication so as to be able to practice in the Courts reasonably successfully. One thing that I had become aware of from I was in high school but which came home to me very sharply early in my practice was the fact of my poor memory for details and that it required that I put in twice as much work in order to master the facts and the law in each case. It also meant that where the citing of authorities were necessary in any case I could not depend upon my previously acquired knowledge of these authorities except as to the fact of their existence and I had to repeat earlier research in order to rely on it again.
In addition to my private practice I, and a number of other persons, especially lawyers, who were aware of a tremendous amount of social and economic injustice in the Jamaican society which led to exceptional civil and human rights abuses especially by the police, got together in 1968 and formed the Jamaican Council for Human Rights, dedicated to fighting against the growing civil rights abuses which were being practiced. Along with the creation of the JCHR I initiated the practiced of filing civil actions against not only against the security personnel who had committed the civil or human rights abuse but also against the state itself, on the principle that the policeman was, at the time acting as the servant or agent of the state. The JCHR has had some significant success in raising public awareness of the prevalence of civil rights abuses by the police, it has also succeeded in getting legislation introduced to curb the practice of wanton police abuses and has by its militance succeeded in preventing the exercise of capital punishment since 1983 until the date hereof. However, further elaboration of my legal practice and related matters must be reserved for another time and subject matter.
Subscribe to:
Posts (Atom)
