Well he is my 'assigned' dr. The scripts for my meds are done automatically and just handed to the quickest available doctor to sign, if they haven't been signed and all I need to do is come to the counter, pick them up and go collect the script when the place opens at 8am. And in person he seems like a decent guy,and unlike most drs he hasn't, post-shipman incident, adopted a policy of under-prescribing. Which can be as bad as overprescribing. Say your in pain, and of a kind thats intense enough that antiinflammatories/paracetamol just won't do anything whatsoever, it certainly to me seems as bad to send them away in screaming agony as it would be to overdo it, worse, assuming the case of overly large dosage is non-fatal and merely has side effects, makes the person puke (not difficult, I have a few times when getting adjusted to different pain meds like when I switched from dihydrocodeine XR (I'd been on the IR version but it is too short acting and takes time to work, being a prodrug so it became effectively impossible to avoid withdrawal each and every day, several times a day, and wake up several times at night sweating bullets and feeling like my adrenal glands are on fire, about to burst, heart rate shooting up etc) which quite plainly isn't acceptable. And besides it didn't control my pain. Going straight to an oxycodone 80mg dose (either XR, twice a day, or extracted and shot although oxy doesn't really have that much going for it in terms of abuse potential really unless massive doses for the level of tolerance a patient has are used) was probably case of overprescribing somewhat because certainly I threw up pretty hard the first few doses taken and had to get a few replacements now and then at first. Although its a lot easier than something like a hangover-puke or food poisoning where you just feel 'oh.my...Chthulhu...I want to die now please' or 'is this going to kill me' respectively?
(actually did think I was going to bite it one time after some serious food poisoning, from food served at a motorway cafe after a funeral, ate a burrito and the day after I was in the ER projectile vomiting green, corrosive stuff that didn't even resemble barf at all, just green, highly acidic slime that would irritate and burn skin if trying to clean it up, blood and bile)
After discharge, next day was readmitted and ended up collapsing in the toilets. I thought I was for it then. Had food poisoning before but jesus, that was a bad one, the kind where you're way past the 'just finish me off already and make it clean and quick' and come right round to 'for fucks sake don't make this the day I end up in a body bag'.
At least though in the case of the oxy he rx'd me (actually the only reason I need to see him currently is to get back one of my books I lent him, a medical treatise from the late 1700s, since he's had it for a while and there is the other volume for him to read (he's done stuff for me too like giving me old copies he didn't need of GP prescribing manuals and might have been him that I got my book on clinical genetics, immunology, immunochemical assay techniques and cytology from although not sure on that) And perhaps he is undercautious at times such as giving me nitrazepam, a strong as hell, very long acting strongly hypnotic-type benzodiazepine tranq, whilst I needed it temporarily for anxiety due to a vexatious pig harassment case, and putting it on permanent RX rather than me coming in as I needed some. Although at least, I'm saying nothing. I know what I can take and how much for how long without coming to trouble and how to taper, so I'm just not going to be the one that turns off the tap, and stockpile the things (they are the somewhat less weight-potent but still real wall-banger type brother of flunitrazepam (rohypnol/roofies), was originally offered diazepam (valium) but I find it too weak and I don't like the benzos that metabolize to oxazepam, which seems to sometimes at least cause paradoxical effects (anxiety, shaking) some time after taking a dose, presumably when the oxazepam has had time to be produced in-vivo) so gave me the one I favour, nitrazepam (I prefer benzos with a strong hypnotic and myorelaxant profile generally, and nitrobenzodiazepines in particular or with at least some other highly electron-withdrawing substituent in place of the nitro moiety in nitrazepam. Its just personal preference, but they are strong for their kind, very much so, and I'm already taking (off license, for seizure prophylaxis) chlormethiazole, another sedative-hypnotic usually used for alcoholic in-patient detox since it has some unique effects on alcohol metabolism not shared by any other sedative-hypnotic/anticonvulsant. Not listed at all for seizure here in the UK in the BNF, only short term as a sedative, and for alcohol withdrawal treatment. I just far prefer it to benzos for several reasons-
mainly, I've been able to take it at first twice daily then thrice daily without any withdrawal effects or even discomfort if I forget, or even skip days (its short acting to intermediate duration, about 5-6 hours), quite surprisingly so, that I've taken it for years without a physical dependency forming. I'd DEFINITELY not get away with that on a benzodiazepine.
Also, its selective for the barbiturate-binding site at GABAa receptors, the same as benzos target, at the benzodiazepine allosteric sites but, unsurprisingly closer to barbiturates in action whilst lacking their mentally dulling effects induced by glutamate receptor blockade of AMPA receptors (its quite different from barbs subjectively, much cleaner headed, and I've had the chance to try some of the proper ones, not just crappy phenobarbital, which is one of the only ones in use other than for surgical anaesthesia induction where ultrashort duration ones like thiopental are used, or methohexital sometimes. Tried 5,5-diethylbarbituric acid, veronal the very first of the barbs to be discovered although it hasn't been used medically for maybe a century or so, give or take a bit. Got that through a genetics lab where its used as a PH buffer)
And it (chlormethiazole) both packs the necessary kick to it to stop an oncoming seizure dead in its tracks, and being highly lipophilic it does so within minutes. As capsules by mouth its likely at least as fast acting as emergency IM shots of diazepam/valium and if the things are opened and the liquid contents emulsified in water and RAPIDLY filled into a syringe without a needle, to stuff it where the sun don't shine, if incapacitated and unable to reach for a bottle of pills etc or to physically take one then that has brought me out of a full blown ictal clusterfuck in about 30 seconds or so to a minute at most, less probably) Speed of onset is insanely fast, which is pretty valuable IMO when a seizure is trying to start and needs to be kicked in the nuts, quickly. Its the F1 motorcar of the anticonvulsant world. Bloody quick but dangerous, an overdose, unlike with benzos (and both opioids and benzos along with it make it more likely, and create more respiratory depression) is likely to kill you. It did for Kieth Moon, from the band 'the who', who'd taken 30-something caps of it, but only 5 had opened and released their contents. Very, very steep dose response curve.
But at the same time, I am certain he (my doc) factors in that I know enough about pharmacology to make an educated decision if one is needed rather than require one be made for me. (actually he's told me on quite a few times where I've backed things up with papers from journals to support being on or off something that I'm WAY beyond his level in terms of pharmacology, kinetics and pharmacodynamics:P not something I rub in his face, he's a decent guy and I have no wish to embarrass him, but it was kinda funny him telling me that I'd been the one teaching HIM tricks he had no idea about (like using cimetidine, an anti-ulcer drug and taken for stomach issues of other kinds) to block two live enzymes that break down morphine, oxycodone and others but that rather than potentiating these, as well as doing so for benzodiazepines never to try it with codeine or tramadol because it'll likely inactivate them, and probably also dihydrocodeine to an incomplete but all the same major extent.
Got a few things not exactly forgotten as such, but I need more nitromethane, nitroethane, debating on more methanol since I've only 5 liters left, I want some 4-dimethylaminopyridine and a new vacuum pump and gauge if I can afford it all. Certainly will be able to afford the nitroparaffins, MeOH if I choose to buy any more just yet, should have enough to last me until next payday and delivery time if I redistill what I use, and afford the para-DMAP plus some pyridine itself (4-DMAP is a quite toxic but extremely effective catalyst for acylation reactions used as an acid scavenger when using acid anhydrides or as I usually prefer, acid halides (E.g acetyl chloride would for many purposes be chosen rather than acetic anhydride, although there are instances when the lower reactivity of an anhydride is more suitable, plus they fume less noxious acid gases than acid chlorides, less volatile and less sensitive to water.
Got a bit over £300 to spend so I hopefully should be able to snag me a new vac pump off ebay if I'm lucky. I want one of those big wide chest freezers too for storing volatile chemicals because I'm running out of space in the chemical fridge.
