Money Saved Is Money Earned

In one of the last posts I did before I lost the energy to continue writing, I talked about the differences in care between a centrally administered health care organization (in my case the Kaiser HMO) and a health insurance model of care. One of the biggest differences is in the way drug prescriptions are handled. While under health insurance, the copayment for commonly prescribed drugs and drugs with generic equivalents was $15 for each prescription. Uncommon drugs or drugs whose patent had not yet run out or there were no generic equivalents available had much higher copayments depending on which supply store or agency you used. In the case of HEP C, the high-copayment drugs needed for treatment were Interferon (Pegasys), Procrit and Neupogen. My copayment for each of these was $100 for a 4 week supply. These drugs had to be ordered many days in advance from an out of state specialty pharmacy that delivered them via express mail. When you added in Ribavirin, the thyroid meds, the Ambien for sleep, Celexa for depression and the Vicodin for the weekly bought of muscle pain, the copayments added up to $375 every 4 weeks. During the 7 months of Standard of Care treatment while covered by health insurance the grand total was roughly $2800 in copayments for the meds.

Under the Kaiser HMO model of care, it is very different both in cost and the ease of getting the necessary meds. Kaiser has all the drugs available through their pharmacy. The is no longer any need for ordering interferon, Ribavirin, Procrit and Neupogen through an out of state mail order pharmacy; a pharmacy that had to send the stuff in an insulated carton with freeze packs and once mistakenly sent the meds to Canada. It can now be picked up at the local Kaiser pharmacy without the necessity for ordering many days in advance to make sure all the necessary approvals are in order. Kaiser also considers a standard order to be larger for some of the drugs than do the health insurance people which means there is more bang for the buck. The copay for the Ribavirin, Celexa, thyroid meds, Ambien and vicodin are still $15 but the prescriptions are for greater numbers of pills each. The interferon, Procrit and Neupogen all have a $25 copayment. In the case of the interferon and Procrit it covers a 4 week supply, for the Neupogen it covers an 8 week supply. Thus a 4 week supply of the necessary meds adds up to about $120. The savings amount to about $1500 for the length of treatment done while at Kaiser. This is not a trivial amount for the folks in my pay grade.

There are a lot of other differences large and small, good and bad, between the two methods of supplying health care and I hope to go into them more in the near future. This difference however, is nothing but good. $1500 saved covers a full month of expenses in my world and that is the same as $1500 earned.

Managing The Serotonin Complex

My previous post discussed the problems I have been having because I am taking Celexa, Trazadone and Tramadol to manage side effects of my chemotherapy. I had a scheduled appointment with my hepatologist this past Friday and decided to bring these issues up at the meeting.

That plan was derailed from the start. When I got to the doctor’s office, my appointment had been cancelled. It was irritating as hell, but they did immediately contact my nurse practitioner Alex who called in the overall Hep C treatment nurse Tammy for a three-way consult. I explained my symptoms and my worries about serotonin overload. Tammy agreed with me that my symptoms could be some level of serotonin syndrome and she and Alex both said I should stop the Tramadol. I told them that the only effective means I had of dealing with the muscle pain I get each injection cycle was to take 800 mg of Ibuprofen every 4 hours. I said it worked fine, but that I had been told it was bad for my kidneys. They agreed but said that in the hepatology department they do not prescribe any opiate-based painkillers. I would have to talk to my primary care doctor in order to get anything prescribed. This sets me up for a great meeting with Dr. K to engage in some classic drug-seeking behavior. I need that stress like I need another hemorrhoid.

I also told them I wanted to change from Trazadone to something else for sleep. They were both resistant to that suggestion. Apparently Trazadone is prescribed along with Celexa and other antidepressants fairly commonly and without problems. I explained that my nervous system is sensitive to drugs and perhaps we should cut back to only one serotonin reuptake inhibitor. They told me that we should eliminate one at a time. Not a bad idea, but then they don’t feel as jumpy as I do.

That was five days ago and it has been a nasty five days indeed. I decided to stop the trazadone as well as the tramadol to try to get my serotonin levels done more quickly. The first 3 days were especially rough at night. My legs were so twitchy that I had to keep getting out of bed to walk around and tire them out. When I got back to be, I had a ten minute window to fall asleep before the twitching would start again and I would have to start pacing, It was a great deal like the symptoms described in this post, but they lasted longer and were more intense. I managed to get about four hours of sleep a night.

The past few days have been better. I have less general jumpiness, irritability and nervousness during the day. The nights are still difficult, but I have been able to get five to six hours of sleep. I am going to try some over-the-counter sleep stuff of some kind if this goes on much longer.

I think I made the right choice to get off the tramadol and the trazadone, but I certainly wish I had a better idea of how long it’s going to take for my body to settle down a bit. I have dealt with restless leg syndrome all my life, but if this goes on much longer I’ll need stronger drugs than celexa to keep me sane…

Minding Your Drug Interactions

Among the disadvantages of being in a drug research study is the tendency for discontinuity in your medical care. The RO5024048 Roche study that I participated in was run by Dr. Natalie Bzowej. It was administered by the Hepatology Center at California Pacific Medical Centers (CPMC). CPMC is a first rate institution and they do cutting edge Hepatitis C research. The doctors are excellent, but as is true with specialists everywhere, they are busy people with many patients. When I screened for the study, I was examined by Dr. Frederick. For early symptoms of rash, sweats etc, I was examined by Dr. Merriman. When I had difficulty with pain issues I was examined by Dr. Bonacini and prescribed Tramadol. Later, when I was having trouble with sleep, I was examined by Dr. Frederick and prescribed Trazadone. When depression issues cropped up, I was examined by Dr. Bzowej and prescribed Paxil. and added Ativan for use as needed. After I reported difficulties with the Paxil, I was seen by Dr. Frederick again and he changed the antidepressant to Celexa Finally, my thyroid function was affected by the research meds and I was put on Levothyroxine by my primary care doctor.

Over time, this can add up to a significant number of medications creating their own set of interactions with each other that have to be carefully attended to. This is something that you should not be leaving solely to the doctors treating you. All the doctors in the hepatology center work on the same team. They are all involved in doing research and, to the limits imposed by patient and study confidentiality restrictions, they communicate with each other and share patient information. However, each doctor has preferred medications they are familiar with and prescribe regularly. This creates a situation in which each doctor is thoroughly familiar with certain meds and they may not be conversant in the effects and interactions of meds preferred and prescribed by the other doctors. You have to do your own research on the drugs you are taking and the potential interactions between them all. I found the drug interaction database at drugs.com to be particularly helpful. If you find something, contact your doctor and get their response. If you feel you need to change drugs, tell them. Keep at it until you get answers that satisfy you.

In my case, I was prescribed tramadol, trazadone and celexa. All have the effect of inhibiting serotonin reuptake in the brain. While this is a good thing for combating depression, if it results in an overabundance of serotonin in the brain, it can cause serious problems: irritability, confusion, tremor, stronger reflex reactions, sweats and potentially even seizures. I do not think these would have been prescribed together if all my symptoms had manifested at the same time. But as each was prescribed for a symptom that was occurring at separate times in the study, I ended up taking them all. There are days when I have to take all three and it is on those days that I have been noticing an increase in my some of my symptoms.

I have increased irritability, a general increase in physical tension and in activities like rubbing my hands, pacing, grinding my teeth, etc. This is all symptomatic of serotonin syndrome which I thought I experienced a few months ago. I am seeing both my primary care doctor and my hepatologist this week and will bring this all up with them both. I would like to see another painkiller substituted for the tramadol and perhaps another sleep aid substituted for the trazadone. I am not sure which way the doctors will want to go but I am tired of feeling this way and need a change.

Anger Management Revisited

I have noticed that anger management issues are cropping up once again as my chemotherapy drags on. In an earlier post, I talked about the first bout of it I had several weeks into the RO5024048 study. It’s coming back again, though with a decidedly different twist. I am not having problems dealing directly with irritating people, but I am having extended arguments with them in my head. I think this could be attributed to one of two side effects or a third cause that is due my current circumstances.

The first would be depression. I am on Celexa and do not feel that I am depressed. I remember what I felt like before I started on the antidepressants and this doesn’t feel like that. I am a bit tenser than I have been and I have a theory about that I am going to check out this week. I noticed that once I started on levothyroxine for my low thyroid function, I became more jittery than I had been before. There was a bit of an adjustment period when I started on antidepressants but that had leveled out a bit by the time I started on the thyroid meds. I then noticed a definite step up in nervousness when I started taking the thyroid meds. I wonder if my thyroid is working better now and my dose is too high and whether the thyroid meds might be interacting with the antidepressants to make me a bit too edgy. I am calling my primary care doctor tomorrow to set up an appointment to test my thyroid hormone levels and perhaps adjust my dose.

The second possibility is the mental problems that can be caused by interferon and ribavirin themselves. It is a known side effect of this combination of drugs that can include irritability, depression, aggressive behavior, suicidal behavior and suicidal or homicidal thoughts. I have not been thinking about killing myself or anyone else. I have indeed thought about letting a few individuals know what I really think about their attitude and behavior and doing it in no uncertain terms. I have imagined these (admittedly one-sided) conversations in vivid detail. I have not, however, actually done any of this and I have not noticed that my behavior towards others has become more aggressive. I am trying to keep a close watch on this and am going to wait for the results of the thyroid tests and any dose adjustments before I address the issue of whether my antidepressants need to be adjusted.

I do note that my behavior has become more decisive, but no one has mentioned that I have been abusive or angry toward them, and I have been asking for feedback if that happens. I find that in situations start to degenerate into indecisive dithering, I am becoming more apt to step in and tell people what to do. This does not seem to me to fall under aggressive behavior in the way they mean in the side effects description, but I am definitely wary of my reactions and behavior.

The third possibility is that some of this is the result of a long hard seven days of dealing with our organization’s biggest event of the year. I have been working longer hours than usual, in more crowded and chaotic circumstances than usual, doing more stressful work than usual. There is nothing like dealing with the sort of obsessive, picky and occasionally barking mad people that populate a used book sale to drive stress levels to the stratosphere. I don’t believe it is entirely due to this circumstance that I am noticing my inner dialogue moving more to “that stupid little prick” sorts of expressions than usual, but it must have something to do with it.

So until I get to see all my doctors about my meds, the knives stay in the drawers and the guns and ammunition on separate floors of the house…

Serotonin Syndrome

I had a bout of serotonin syndrome during the past several days and it was quite an experience. It began last Wednesday the 27th as I started to feel a bit jittery while at work and had a few episodes of chills that evening when I was going to bed. I continued to feel jittery, nervous and had some muscle twitches on Thursday. I went to the Giants game that afternoon (it was a 4:05pm start) and got quite chilled by the end of the game. Even after arriving home I noticed that I continued to be cold and had a lot of jitters and muscle twitches.

This reminded me a great deal of the physical situation I encountered when I started on Paxil and, to a lesser extend, after I switched to Celexa. It seem unusual that this should be happening several weeks after beginning antidepressants, so I began examining my recent use of meds to determine what might be happening. I believe it was related to the pain medication tramadol.

The past few weeks I have had a bout of fairly serious lower back pain. I have been dealing with this sort of pain for about 20 years as the result of a serious bicycle accident (over the handlebars, on the pavement, laid up for a month sort of thing). It is something I have managed by stretching, core exercises and, occasionally muscle relaxants. It flared up about 10 days ago with pain across the lower back, around the sides of the pelvis and even with some sciatic pain radiating down my right leg. It made it impossible to sleep and even tough to work while sitting up. I immediately started in with my stretching routine and exercises but until they began to take effect I was taking tramadol at least twice a day and on a few occasions 3 times a day.

I remember when I got my prescription for Celexa; the pharmacist took me aside and told me that he noticed I was also taking tramadol. He stated that while tramadol is not a serotin uptake inhibitor specifically, it has a similar chemical construction to Celexa and I should be careful not to take too much of it while taking the Celexa as it could lead to an oversupply of serotonin in the brain which causes serotonin syndrome.

Symptoms may include:
· Restlessness
· Hallucinations
· Loss of coordination
· Fast heartbeat
· Rapid changes in blood pressure
· Increased body temperature
· Overactive reflexes
· Nausea
· Vomiting
· Diarrhea

As soon as I remembered this conversation, I immediately stopped taking tramadol and instead used ibuprofen for any pain. I still took my dose of Celexa but I noticed that it did not get any worse on Friday and by Saturday it had begun to moderate somewhat. After a jumpy night Saturday, Sunday has been okay with a gradual reduction in nerves, chills, sweats, etc. I think it is well on the way to returning to normal over the next few days.

I am definitely going to paying closer attention to my use of tramadol and will be talking to my hepatologist about potentially switching to another pain med for the times I need it. At least I recognized the symptoms as being similar to the range that occurred at the start of the antidepressants and could make the connection with the serotonin.

On the positive side, though I would not recommend it to anyone, I lost four pounds in four days due to the amplified nervous activity from the serotonin. But do not try this at home. It is much better to be fat and happy than slightly less fat and jittery as hell.

New Morning & Another Reason for Keeping Notes

It is very clear to me now both why doctors prescribe antidepressants and why patients endure the early symptoms until their brain chemistry stabilizes and the drug begins to work. I feel…better. It is a curious state to attempt to describe. As my friend BS says, “You generally don’t notice feeling okay or good, but you do notice when you feel bad.” There is also the fact that as you experience a particular state for an extended period of time, be it either feeling good or feeling blah, you come to take it as your normal state and forget that you used to feel differently.

In my case, I realize now that the treatment regimen had gradually been grinding down my mental energy and state of mind. I had not noticed it as it happened though the folks running the study, and AVB in particular, claimed that they could see it happening to me. They actually had the advantage of seeing me intermittently as opposed to every day. This allowed them to notice the changes more clearly because they showed up as significant differences. It’s like the first time you spend some serious time away from home. When you return you notice real changes in your parents and siblings that would not have been nearly so obvious had you been with them on a daily basis. Likewise with me, my wife and I were immersed every day in the grind of treatment and thus the incremental changes became what were normal as opposed to something we should be paying attention to. If nothing else, the declining number of posts per month to this blog should have been a tip-off that the depression and why-bother attitude induced by the interferon were taking a very real toll.

Now that I have been taking antidressants for about 3 weeks and Celexa in particular for about 10 days, I feel a bit better; a touch more mentally alert; less likely to have the why-bother attitude. I still get tired and lose the ability to concentrate by early afternoon, but now when I get home, I don’t just drop onto the sofa and watch a couple hours of awful television in a kind of passive stupor. I still turn on the TV, but I now get bored after a while and find something else to do. The ability to be bored by stupid, mindless crap is a great gift of mental achievement that has been returned to me by modern bio-medical research and I am grateful.

This is yet another reason to keep notes about yourself while you are in treatment. If I had done nothing more than record the number of hours I was watching television, it might have tipped me off that my mental outlook was going downhill. So take notes, date them and look them over from time to time as treatment goes on. You have to review them regularly because the interferon is going to fog your brain and ruin your memory during treatment. If you do these things, you can stay ahead of the side effects and do your doctors a great service by having good information to give them. Both of these things will help you come through you treatment more successfully.

PS: A purely personal note about Celexa because it means a lot, SEX IS BACK!

Back on the Interferon Bandwagon

After a reduced dose of Pegasys two weeks ago and a skipped dose last week, I am back under the hammer, so to speak. The dose reduction was due to my neutrophils being below 500. The study doctors believed my neutrophils would rebound without the interferon pounding down the white blood cells. They were right. The number popped up to 1250 and they put me back on a half dose of Pegasys.

It is amazing how much you can forget in 20 days. While I had a lot going on the past few weeks what with the acclimatization side effects of the antidepressants and the new drugs I was taking because of it, nonetheless the number of interferon related physical symptoms that disappeared without my noting their passing surprises me.

I injected Thursday evening and that night I had night sweats and had to change my t-shirt twice. By Friday late morning/early afternoon I had the mild headache and general crappy feeling in the head that you feel when you are coming down with something. By 5:00 p.m. my muscles started to ache, especially in the butt area (How can you mindlessly watch TV while feeling crappy and sore if you butt is aching?). That night I had a generally stuffy head and by Saturday morning the middle of my back was stiff and cramping. I had my first wave of nausea around noon and I also had a sore spot in my breast but with my general clumsiness of late, it could easily be the result of my running into a door, or wall, or chair, you get the idea.

All of these symptoms had disappeared over the past 20 days. Their disappearance was accompanied by completely forgetting about them. I didn’t really even register the fact that I hadn’t felt nauseous in almost three weeks. That would seem to be the sort of thing that you might take note of.

I think this points up the importance of keeping notes about your general health, side effects and mental state throughout your treatment. It doesn’t have to be elaborate. Just a small notebook wherein you note how you are feeling generally and any unusual or unique effects you are feeling. It really helps to be able to flip through you notes and realize that a particular symptom or side effect or your general state of health and feeling is something that you have experienced before. The interferon really affects your concentration and memory and it is very easy to completely forget about something earlier in the treatment cycle that seemed it would be unforgettable at the time. So make notes and keep records. A little notebook of the history of your treatment can be a great friend to you when something seems to be coming out of nowhere, but actually happened to you in the past.

Doing The Serotonin Space-Out

The speed rush has finally mellowed. I am no longer jittery with loads of nervous energy. I am now in a mostly calm and definitely spaced-out frame of mind. There is still a bit of jumpy legs and feet that comes on in the evening, but half of an Ativan generally calms that down.

It is difficult to describe the state I find myself in. It feels as though both of my eyes are not focusing together. While I can see clearly when I concentrate on something, those things at the edge of my visual field seemed to be focused at different distances. When I turn my head and move my visual field it has to come to a resting point before everything seems focused. It is as if there is a piece of slightly distorted glass between my eyes and what I am looking at.

This feeling is not disconcerting because my mental state is definitely toward the unconcerned side of the spectrum. I find both the visual and mental effects to be interesting, but ultimately of little matter. I am concerned enough to limit my driving to the minimal I need to do to handle my treatment and occasionally my job. I don’t intend to return to driving as much as I did a few months ago until this all settles down.

There is an additional side effect which is of concern. The fact that it is important to me and yet still does not make me upset or anxious certainly speaks to the power and effect of the antidepressants. Antidepressants in general and Paxil in particular can cause side effects in your sexual functioning. I have noticed a definite and extreme drop in my libido. I don’t much care about sex and indeed have not had an erection in about 5 days. The few times I have achieved an erection and engaged in sexual activity, I have found that it is impossible to have an orgasm. This is most frustrating and that frustration can cause a real impediment to the intimacy that sex brings about between two people. You are much less inclined to want to do it if there is no payoff at the end of the process. The wife of an old friend of mine had the same problem when she was on Prozac. She still liked sex but the complete inability to have an orgasm eventually drove her to swear off all antidepressants.

I am not going to go that far, but I am going to talk to my doctors. I am going in for yet another blood redraw (the 10th time) and will sit down with them and go over the side effects I am experiencing. There are a wide range of antidepressants with a number of mechanisms for achieving their effects, so it is certainly possible to switch from one to another until you find one that works best for you.

It is most important to keep in close touch with you doctors about the effects whatever antidepressant you are taking is having upon you. If they are debilitating or just very difficult to endure, talk about changing drugs. There are a wide range of them. All individuals react differently to the individual drugs. So moving from one to another to find the one that works best for you is standard procedure for these drugs. Do not let your doctors tell you that you have to endure difficult or debilitating or scary side effects. You do not and in fact have the right to get the best treatment for your situation.

So use the calm resolution that you are striving for to stand up to the man if you have to. Insist on your right to the correct drugs. Make sure that you keep communications open so that you and your doctors can finally settle on the treatment modality that is best for you.

Believe me, it’s better than being spacey, impotent, anxiety-ridden or suicidal, really.

Riding Out The Rush

Wow, I have not had this powerful an effect from a chemical compound since my experiments in reality hacking over 25 years ago.

I took my first dose of Paxil before going to sleep on Saturday. I woke up by 6:30 a.m. on Sunday (very early for me to awaken on weekend) and could not get back to sleep. I felt a bit restless so I did some yard work in the morning. In the afternoon my wife and I went for a walk and I noticed that I was becoming increasingly spacey and tired. Back at home, I napped for about an hour and woke up to a splitting headache. Ibuprofen handled that and being a bit tired, I went to bed just past 9:00 p.m.

I woke up at about 6:00 a.m. Monday and I was wired. I felt jittery and full of nervous energy. I would sit down for a bit, then get up and pace around the house. I could sit and read the paper, but as soon as I was done with a story, I would get up and pace. I realized my inability to concentrate for any period of time would make going to work useless, so I called in sick for the day. I called my various health professionals to ask if this was a normal reaction or extreme. Their reply was that it was at the upper edge of normal and if it continued for very long to let them know. The rest of the day was about the same and I took some of the Ativan at night to try to calm down the jitters.

Over the next few days the jittery nervous energy gradually moderated. I was able to go to work for a few hours a day until I got so physically restless and mentally scattered that I had to go home. I found myself compulsively doing little things around the house because I could only read for so long before I had to get up and move around and do something. I took small doses of Ativan during the day to steady myself out and returned to taking trazadone to sleep, which helped a great deal.

On the bright side, since starting on the Paxil, I have not felt nauseous at all. In fact all the muscular tension and nervous energy have actually made me hungry for the first time in weeks. Despite this, I have lost 5 pounds in 4 days since starting the drug.

This is definitely Mr. Toad’s Wild Ride going on in my body. Once again, I feel lucky I did a fair amount of reality hacking in my youth because I have clearly recognized that all the side effects I am going through are definitely drug-induced. I’m not going crazy or having anxiety attacks, I am just experiencing a drug reaction. But for the folks out there who haven’t had much experience with drugs that have a direct effect on their mind, this could be a scary experience.

Which leads me to a last comment. Doctor NB did not spend any time going over the commonly occurring side effects of Paxil or explain how much time they continue on average. This would have been a great help and, again, anyone without drug experience who was not prepped about the side effects could have real problems dealing with them.

So now we get to see how the rest of the ride goes. Stay jittery, steady out, maybe even achieve some chemical balance and generally calm down, stay tuned folks, it may stay bumpy…

Coming In Off The Ledge

We finally had the conversation about antidepressants this week, 21 weeks into the trial.

It came about because I had been noticing that I was feeling an increase in impatience and tension during conversations with people. They were the sorts of conversations you have all the time with co-workers, your partner and your friends. It seems that when I would talk to my wife in the evening about how her day had gone, I could feel myself get tense if she talked for very long at all. The same thing happened with co-workers. I found myself thinking, “all right, I get it, you don’t have to keep going on about it, just leave me alone.” This did not happen all the time, but it was increasing in frequency. Just a note, I was not saying any of this stuff aloud, but I was thinking it, sometimes forcefully.

The study coordinator AVB called me to tell me that they needed to redraw blood because my neutrophil count was so low. They wanted to determine whether to adjust my next interferon dose to a smaller amount. I mentioned that I had been noticing a subtle change in my mental state the past few weeks and told her the nature of it. I told her that when I came in two days to do the blood draw, I would like to talk to someone about whether something needed to be done. She said that I should come in immediately. It took awhile, but I managed to convince her that it wasn’t so serious that I was going to start running people down in my truck or screaming at my wife and coworkers. She finally agreed that it could wait till Friday and we left it at that. Her main concern from years of experience was that these sorts of small changes could quickly escalate. Her example was a patient who suddenly started ramming people with her shopping cart at Costco because they weren’t moving fast enough. I promised I wouldn’t do any shopping before Friday.

When I came in for my appointment, they did the quick blood draws and then AVB quizzed me at length about my mental state. I repeated what I told her on Wednesday and then answered her questions about all my various side effects. She told me that even though I had been telling her that I was getting along okay over the past several weeks, she had been noticing some deterioration in my mood. She said that even though I was a tough guy who was intent on soldiering through the treatment, she had “seen it in my eyes” that I was having an increasingly difficult time. I had to tell her that she was about the only person I could remember who ever used the words tough guy to refer to me. Sure I have a generous helping of Slavic fatalism, midwestern quiet desperation, and general stubbornness, but actual toughness, not so much. Nonetheless, she paged the study doctor NB to come in and go over the situation.

When Doctor NB arrived, we went over the same material and discussion of mental state and symptoms. She concurred with AVB that I might be approaching a tipping point in my mental state. Her solution to the problem was to prescribe the antidepressant Paxil. She also prescribed Ativan as something to take when needed if I felt anxious. She said that Paxil can take 2 weeks or more to take effect and that the Ativan would be something to use as a bridge until the Paxil kicked in.

So now I will be starting antidepressants as soon as I fill the various prescriptions. I am not sure what to think about that or what to expect mentally when I start taking them. I have no real feelings about antidepressants, though they do defeat the concept of Slavic fatalism. My wife took Paxil about 15 years ago and it helped her a great deal. I have also found, through talking with other individuals who have gone through treatment, that I am one of the few people who started treatment without being given antidepressants right at the start of treatment.

When I told my wife that I was going to start taking Paxil, she reminded me that for the first few days she had taken it she felt “rubbery.” While we have no idea what my reaction will be to starting the drug, I am definitely expecting some sort of side effects at the beginning. I guess it’s time to hit the internet and start my research…