Brief Answer:
Obvious solution is to stop the Ativan but under doctor supervision

Detailed Answer:
Good evening....Thank you for placing a concern of yours on this network and allowing us the opportunity to help you.

Though you haven't provided a specific question I'll take a guess that you would like to know about options to getting your urine stream back up to normal assuming it's due to the medication.

My first question would be having to do with your normal baseline bladder function in the face of being a paraplegic. I'm assuming that that it was the gunshot wound from Vietnam that caused the paraplegia? One possible solution to this problem would be to simply stop the offending medications. Of course, that idea is only as good as the reasons for which you're taking them in the first place. The 2nd issue is stopping the medication in a controlled manner since it can cause some withdrawal symptoms which if not careful can land you up in the hospital. So do not stop the medication without your doctor knowing about things and actually, giving the instructions as to when and how to do that.

You may be on the medication for the purpose of relieving spasticity in the legs (stiffness) which may help you walk, may relieve some elements of pain, and may make it easier to get dressed and undressed as well as doing your transfers.

You may also be using the Ativan for symptoms of anxiety, nightmares, or other sleep disorders which have not responded well to other interventions. If the use of the Ativan (which by the way is the same as Lorazepam chemically speaking) has become either excessive or you are not able to relinquish its use then, there may be dependency issues which will have to be dealt with before you can think of phasing it out for the purpose of improving urinary flow.

The other question that needs to be asked is whether or not the slowing down of urinary function could possibly be due to the paraplegic state if it is involving the lower thoracic/upper lumbar segments at all.

Therefore, I believe that other questions and considerations need to be accounted for before a sound approach to urinary flow problems can be dressed. Most importantly would be to actually know that the use of the Ativan is the cause of urinary slowing. For there to be significant slowing of urinary flow strictly on the basis of Ativan but yet no other organ systems are affected is a bit of a stretch in my opinion. Of course, it's going to be hard to fully assess bowel motility or pathology from a clinical point of view since the paraplegia in and of itself is already a huge contributing factor to slowed GI motility and therefore, you may already be constipated or even suffering from impaction.

Has urology taken a look at this problem using a post residual voiding test? Has neurology confirmed bladder dysfunction using EMG studies? What is Ultrasound saying about the bladder, the ureters, and kidneys? Is there any hydronephrosis suggesting urine backup or retrograde pressure due to bladder dyssynergia? Do you have any autonomic function studies to assess some of the basic functions such as blood pressure, heart rate, cardiac compliance, respiratory function, and orthostatics?

These would definitely be some other ways to gather data on what's going on with the urine before actually implementing any specific intervention or treatment suggestion.

I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues I may be able to help answer.

I'd appreciate your rating this interaction on a HIGH STAR SCALE if you found the information informative and would be grateful for a few words of feedback.

Write to me at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if possible. I'd like to know how things turn out for you as the information may help guide opinions in patients with similar issues.

All the best to you during these holidays!

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