Brief Answer:
Not sure exactly what the main question is in this statement but here we go

Detailed Answer:
Good morning. I'm a neurologist from the Ohio region of the world. I'm sorry things aren't going the best for you but here are some thoughts specifically focused on each of your statements since I'm having a hard time finding the EXACT question you are trying to ask:

1. I would need much more information about your headaches and especially on the frequency with which you are taking IMITREX for your headaches to tell whether you may be OVERUSING that medication above manufacturer's recommendations which could actually produce even worse and more unbearable headaches. This could be one reason why you are having to reach for Demerol. I am a headache specialist and can tell you that Demerol as a choice to treat headaches is not what we consider very good....even if it is the "last ditch resort."

I highly recommend you find a HEADACHE SPECIALIST locally and have your case reviewed by them. You need to straighten that problem out for sure in order to substantially improve your quality of life, in my opinion.

2. Medical leave for "pre-senile dementia." Without seeing the neurological/medical examination and neuropsychological examination and interpretation I can't say for sure....but I would question any diagnosis of "pre-senile dementia" in a person who has other intervening medical issues as well as possible psychological behaviors due to sleep disorders of some sort. I would be get a 2nd opinion on this diagnosis of dementia because that sort of diagnosis CANNOT be made haphazardly and needs to be backed up with testing data. My gestalt says that you probably have no such diagnosis.

3. I am not a great fan of Restoril for sleep based upon its ability to CREATE INSOMNIA due to its "rebound" effect. There are much more specific medications available as sleep aids (Ambien, Sonata, Lunesta). I would ask the primary doctor if you could be referred to a SLEEP SPECIALIST for a study looking for PARASOMNIAS and very possible an REM sleep disorder.

4. An REM SLEEP DISORDER should be sought given the history you are describing and may be the reason you are worried about hurting someone else at home if you slept with them in the same bed.

5. If the sleep specialist can definitely diagnose the presence of NIGHTMARES being present then, a specific medication to treat these entities is available called PRAZOSIN.

I hope I've satisfactorily addressed your questions. If so, may I ask your favor of a high star rating with some written feedback?

Please send me more comments or inquiries in the future by going to my web address at:

bit.ly/drdariushsaghafi

I would be honored to answer you quickly and comprehensively. Please keep me informed as to the outcome of your decision and your testing results.

This query has required a total of 17 minutes of physician specific time to read, research, and compile a return envoy to the patient.

---

Brief Answer:
Get rid of the pills!

Detailed Answer:
Dear Mr. XXXXXXX

Thanks for your reply. In brief, I just got done writing an answer to another patient's question who has many similarities to your case in that he also is taking a pharmacy full of drugs. I will say to you what I said to him and what I say to all of my patients. I fully disagree with the use of SO MUCH MEDICATION in our society and our culture....it's absolutely insane and the only people who can really stop such crazy behavior..in my opinion?....are the patients. I don't know when or how that can happen with such pressure from doctors and pharmaceutical companies to please "enjoy the benefits of technology and advanced medical science!" A pill for every ill used to be the drug company's motto back in the '50's and that saying has served them well over over a half century.....People and Doctors need to wake up...quickly otherwise, we are going to be in more trouble than any economic disaster or geopolitical disaster can make us....

The only thing worse than a drugged up and drugged out society "spinning out of control" as you put....may be the Sun exploding and becoming a Red Giant tomorrow.....according to all scientific accounts..that would clearly spell the end of humanity....But prescription drugs being doled out like candy to patients without expecting any responsibility on either patients' or doctors' parts is just as aggressively killing us though it might take us a tad bit longer than the sun exploding and frying us in 30 minutes from detonation! LOL....

Dementia is a different entity altogether than medication induced encephalopathy. By the way you write your questions and the content of your thoughts that I can detect (as a NEUROLOGIST....NOT a psychiatrist/psychologist) I do not detect any element that I would be able to legimitately say falls into the category of some form of dementia, of which there are several.

But yes, you certainly sound as if you are in a situation where the term POLYPHARMACY can be legitimately used and I wish I had the easy answer for how to help you "kick that habit." Again, going back to the last question I answered for the other patient....I must repeat myself.....nobody will make the decision for you to release yourself from all those pills except yourself. I doubt it can be entirely done cold turkey....there are probably drugs that would be contraindictated to stop that way anyhow.....but I believe that for you to be able to turn things around YOU MUST GET THOSE PILLS OUT OF YOUR LIFE.

I wish you were a bit closer geographically.....well, A LOT CLOSER geographically to XXXXXXX because I think there could be possibilities that we could work together and I MIGHT BE ABLE to cajole you in a "passive/aggressive" way to break free from this absolutely no win situation with all the medication you are apparently taking.

I can't say much more about taking medications that would turn your thinking around that you already don't know. Here's one thing I tell patients who are in my headache clinic, for example.....I ask patients who are ADDICTED let's say to bottles of Tylenol or Aleve or Motrin for their headaches, got the picture?

These are folks who are referred to me with chronic histories of daily and nightly severe headaches that simply don't go away. At the same time they are taking bottles of OTC medications on a weekly/monthly basis....I mean we're talking about 150-200,000 MILLIGRAMS of medications monthly for their headaches.

And does it help? Does it cure their headache? Does it make them feel good? Does it seem like they've made progress? Of course, you know the answer to those questions.

So then, my simple question to them is, "Then, why are you taking these pills?" And their answer is, "Well, I HAVE TO TAKE SOMETHING for my headaches." It takes a lot of effort for me to get some of them to realize that what they just said makes absolutely no sense whatever. They readily admit on the one hand that nothing works for their headaches yet they are compelled to take something because that's simply how life works for them anymore.....a pill for an ill. Notice that the saying doesn't stipulate anything about whether that pill for that ill is under any obligation to actually carry out its mission and cure anything......

It's simply a pill for an ill.

So, I ask you...what have you cured with all the medication you take? Are you truly better off taking all the medications for your conditions than before you took any medication at all for anything? Mind you I'm excluding drugs needed to sustain life such as anti-arrhythmic drugs, or anti-epileptic drugs necessary to prevent true blue organic disease that can kill a person if not taken.....but all the rest of it? Has it really made your life that much better that you couldn't find an alternative way of living WITHOUT the pill to get the same result?

Why do people take illicit drugs? In general, most people would tell you, "To feel good" or to "forget about things." Well, are there not alternative ways to feel good....such as how one feels when they've accomplished their daily agenda of tasks that they set out to do....or when they have just completed a great physical workout in the gym, know that they really pushed themselves and exceeded expectations, and feel fit and trim, etc. etc.......isn't that a way of getting a "high" or feeling "good"? But that's a lifestyle behavior that doesn't last but more than a few minutes at a time.....you'd have to do that every day for it to really work consistently...and then, you'd still have to do it every day after that....???? Huh??? That's tough work man....easier and less time consuming to just take pills...same result.....but is it the same result?

I say not....food for thought my friend....food for thought.

Your cognitive dysfunction (if I can just generically refer to it as that) in my opinion is based likely on polypharmacy considerations...not organic dementia. If you've been adequately screened of course, for thyroid considerations, Vit. B12, folate, Vit. D deficiencies and corrected then, the problem is most likely that and not organic disease.

And I wouldn't doubt that all the drug to drug interactions and reactions are at least in part responsible for what's going on with your sleep disorders and behaviors.

One last time....there has to be a good sensible way for you to get rid of ALLMEDICATIONS (notice that I made 1 word out of that....!....clever, huh?). You MUST get rid of ALLMEDICATIONS that are not life sustaining and replace them with lifestyle changes and/or activities of a productive nature that will substitute. You need to speak to an addiction specialist perhaps on how to overcome your feelings that you must have drugs to survive....or perhaps, a psychiatrist with an interest in addiction medicine....they need to know what type of personality traits you possess that make this such an issue.

I do wish you all the very best....and if you do ever want to consider something crazy like having a doctor in XXXXXXX that you see every now and again....think of that as a STRONG MOTIVATOR to succeed, right? If you had to spend your time and money coming all the way out to XXXXXXX for a checkup appointment and you couldn't vouch or prove that goals we set for you previously were achieved or reached....then, what type of waste of time and resources would that be for you? Well, crazy idea....but I'm around on the shores of Lake XXXXXXX (shallowest of the 5 Great Lakes) and biggest city in the world when it comes to Rock 'n Roll! LOL.....

Be well....

Good luck on putting the ball in the play......KEEP YOUR EYE ON THE PRIZE MAN!

I hope I've satisfactorily addressed your questions. If so, may I ask your favor of a high star rating with some written feedback?

Please send me more comments or inquiries in the future by going to my web address at:

bit.ly/drdariushsaghafi

I would be honored to answer you quickly and comprehensively. Please keep me informed as to your decisions and commitments on things.

This query has required a total of 50 minutes of physician specific time to read, research, and compile a return envoy to the patient.

---

Brief Answer:
Review of medications

Detailed Answer:
I've looked at your list of medications and other information you've provided and obviously there are great limitations in how far any physician could really go either criticizing or suggesting alternatives since YOUR doctors are the ones who have the most knowledge and time evaluating your conditions, seeing how you respond to certain things and others not, as well as getting to know you as a patient and person that clearly shapes the decisions of what gets prescribed and not prescribed.

I feel that I would not be overstepping any boundaries of a professional nature by drawing to your attention 2 items:

1. Imitrex (as well as any headache medication prescribed for the treatment of acute episodes of migraine) should be carefully monitored and not overused nor overprescribed by health care providers. There is a clear consensus by headache experts that medications such as Imitrex (i.e. triptan drugs and other more complex migraine treatments) should be limited to no more than 10 days of usage PER MONTH. In my headache clinic I go 1 step further to limit patient usage to 10 DOSES per month of these drugs. The reason is due to something called MEDICATION OVERUSE HEADACHE. If you are using Demerol for headaches then, again, there would be even a stricter line drawn since the COMBINATION of doses between Imitrex and Demerol should not exceed 10 DAYS or in my particular opinion 10 DOSES per month.

2. If Temazepam is being used as a sleep agent I would suggest that many other more specific medications are available to help with issues of insomnia if that's the problem and that the use of an agent such as Temazepam on a long term basis is risky from a dependency point of view. Having said that it is also recognized that other specific sleep agents such as Ambien, Lunesta, Sonata can and do produce conditions of dependency and withdrawal which can be just as tricky to deal with successfully. Still, I simply bring this point up as a way of possibly having a discussion point available with your doctor that perhaps they would consider this if he hasn't already.

3. A little known fact in headache medicine is that a medication which is currently mostly used for treating Alzheimer's dementia (NAMENDA) has been shown to be successful in treating people with chronic daily headaches of the migraine or tension type and may be just as efficacious as more standard and common prophylactic/preventative medications such as propranolol, tricyclics, or antiepileptics.

Your doctor may wish to seek advice from a HEADACHE SPECIALIST colleague if unsure of how to use NAMENDA for this type of condition.

Once again, thank you for the opportunity to serve your medical question needs. I hope this information can provide talking points for you and your physician for future adjustments to your treatments as appropriate.

As this is the final question in the series that you initiated under the type of question you chose to ask I would ask that wrap our discussion up with this message. I'd appreciate your CLOSING THE QUERY and rating this transaction with a HIGH STAR EVALUATION with some written feedback.

If you would like to continue discussing this or any other issue please reopen a new query by going to:

bit.ly/drdariushsaghafi

and I would be happy to respond in a timely and comprehensive manner.

This query has required a total of 100 minutes of physician specific time to read, research, and compile a return envoy to the patient.

---