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Old 12-01-2005, 06:42 AM   #1 (permalink)
PARTY! SUPER PARTY!
 
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182: Friendly Skies

"When did we become homeless?"
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Old 12-01-2005, 08:37 AM   #2 (permalink)
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It's about time the ignorant crackers down here learned how to speak without the accent. Sure, I'll speak in casual southern when I'm talking to the guys out in the bay (I'm an office worker) because they do. It's not a put on either, I'm surrounded by that and it is the way about40% of the people in the city talk and about90% of those outside.

In fact, where I am, until they built two new schools (aah, I can feel my property value rising) it would have been better for us to hop over a little and get into the county, as their schools were much better, but you get the accent.

My wife, when younger and definately sassier, when asked why she didn't have an accent, would reply "I was raised by an educated family." Which is funny, since both her mother and father were rural Alabama people, but somehow figured out how to pronounce stuff correctly.

Note: We do have accents however. When a southerner tries to lose his accent, it ends up being more of a Texas accent. But then again, Standard American English is just based on people in Ohio, minus the Warshington crap. In fact, if I get north of St Louis, people know I'm from the south. Heck, when in Mexico, I had a guy tell me that he could tell I was from the south and that my Spanish teacher was a Puerto Rican. He was right.
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Old 12-01-2005, 09:54 AM   #3 (permalink)
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Question What letter?

Dude, what happened to this "alleged" letter you received from me?

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Old 12-01-2005, 10:59 AM   #4 (permalink)
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the first 13 years of my life were spent in georgia...then i moved to ky, fl, tn...and i never got an accent. i don't know how. i just never did.
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Old 12-01-2005, 11:14 AM   #5 (permalink)
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Mmmm, Lithium water.

Quoted from Crazymeds (hopefully Jerod won't mind):

Generic Name: lithium carbonate

Other Forms: lithium citrate syrup

Class: Officially lithium is classified as an antipsychotic. Really it's one of two true mood stabilizers. All the other meds that people call "mood stabilizers" are really anticonvulsants and are best used as anti-manics. The exception being Lamictal (lamotrigine), which is the other true mood stabilizer.

FDA Approved Uses: Acute and chronic bipolar mania. For thirty years the lithium meds were the only meds with FDA approval to treat mania that lasted longer than six months. As of early 2004 Zyprexa (olanzapine) just received approval to also treat chronic mania. Were supposed to stay on our meds but there are only two meds approved for use long than six months. Isnt that crazy?

Off-Label Uses: Cluster Headaches (although it still appears over the years not to be that effective), augmenting antidepressants to treat refractory Depression, Graves Disease (hyperthyroidism).

Lithium's pros and cons:

Pros: The gold standard for classic bipolar 1. Inexpensive. Consistent. Available around the world.

Cons: The side effects suck donkey dong! You need to have regular blood tests. Changes in other meds, diet or even the seasons can require an adjustment in your dosage, but youll need a blood panel to determine that. Usually doesnt help much for non-standard forms of bipolar disorder (e.g. rapid cycling, bipolar 3-6).

Lithium's side effects:

Typical Side Effects: Weight gain, tremor (sometimes bad enough to require a beta blocker such as Inderal to quell it) and acne. Itll be just like two weeks before the Junior Prom and you still dont have a date.
These aren't all the side effects you can get, just the most popular ones.

Not So Common Side Effects: While every day wont be as bad of a hair day as with a valproate, lithium does mess with your hair. Food will sometimes have a salty or weird metallic taste added to it. There can be edema and other mysterious swellings. You may not think as clearly as you did before you started taking a lithium variant. While valproates may turn you instantly old, lithium will force you to relive your adolescence.
These may or may not happen to you don't, so don't be surprised one way or the other.

Freaky Rare Side Effects: Anorexia, not feeling anything on your skin, not being able to move your limbs completely. Those wacky adolescent fantasies about becoming a Barbie doll lithium can make them happen!

You aren't going to get these. I promise.

Interesting Stuff Your Doctor Probably Won't Tell You: Lithium toxicity has resulted from interactions between an NSAID and lithium. Indocin(indomethacin) and Feldene(piroxicam) have been reported to increase significantly steady-state plasma lithium concentrations. There is also evidence that other nonsteroidal anti-inflammatory agents, including the selective cyclooxygenase-2 (COX2) inhibitors (e.g. Celebrex), have the same effect. In a study conducted in healthy subjects, mean steady-state lithium plasma levels increased approximately 17% in subjects receiving lithium 450 mg BID with Celebrex (celecoxib) 200mg BID as compared to subjects receiving lithium alone. Ibuprofen and Aleve(naproxen) can also affect lithium levels.

Prozac (fluoxetine hydrochloride) and lithium can cause unpredictable serum levels. Be sure to have regular level checks if mixing the two.

The way lithium works in your brain can wind up canceling the effects of some blood pressure medications. Or the other way around. So if youre taking blood pressure meds that work on sodium channels, lithium may not be for you.

You really do need to drink between 2.5 and 3 quarts/liters of water a day when taking lithium. Thats on top of whatever other fluids you might like to consume. Lithium isnt really metabolized, it petty much hits your brain as is and is then flushed out of your system, mainly via your kidneys. A lot of the problems people have with lithium stem from used lithium hanging around the exit.

Lithium's Dosage and How to Take Lithium: For bipolar disorder the lithium meds are all about your blood serum levels. The sweet spot is somewhere between 0.6 and 1.2. Good doctors will take into consideration your age, weight, previous history with medications (if any), and just how freakin manic you are at the time to determine where to start you. Lazy doctors will start you at 900mg a day if youre mildly crazy and 1800mg a day if youre climbing the walls.

Unless you or your family member has utterly lost it with mania, Im for starting out at 450mg a day for controlled-release versions (Eskalith CR, Lithobid, Duralith, etc.), 300mg a day for immediate release. That is highly unlikely to get you near the therapeutic level of 0.6, but it does allow you to acclimate to the lithium. After a week you get a blood level and you see where you need to go. Probably up, but you never know. Mouse would get lithium toxicity above 100mg a day. One week at 300mg a day was enough to give me 12 years worth of tonic-clonic seizures. Granted we are autistic-bipolar-epileptic freaks of the first water, and while anything is possible in the world of psychiatric medications, it is highly unlikely lithium will hit you as badly unless you are also an autistic-bipolar-epileptic freak.


How Lithium Works In Your Brain: I'll have to get back to you on that. But the best guess I've read lately is that it has to do with sodium channel voltage. So it's sort of like some anticonvulsants, but sort of not. Once I have a better idea I'll let all y'all know.

Odds of Working and How It Compares to Other Meds: I'll update this section later, but for now suffice to write that lithium works best for classic bipolar 1.

Comments: The first, least expensive and gold standard of mood stabilizers. Lithium has been in use since the early 1800s, has been used to treat psychiatric ailments since the 1880s, and was first used for manic-depression in 1947, and approved by the FDA to treat bipolar disorder in 1970, thus the first of the many off-label meds used to treat bipolar disorder. Although often described as the first mood stabilizer, I think that Thorazine (chlorpromazine hydrochloride) may actually have been approved to treat bipolar disorder first.

Lithium's long-term effects are very well documented. Along with Lamictal (lamotrigine) it is the only FDA-approved mood stabilizer proven to work for bipolar depression. Symbyax, we note, is an antidepressant specifically formulated for bipolar depression.

Originally I was going to have separate entries for the different brands, but after looking at the anecdotal evidence, there wasnt much point. While Lithobid may be better on one persons tummy than Eskalith-CR, thats an uncommon situation. Lithium is basically lithium.

Lithium is all about blood serum levels. The therapeutic level of lithium is somewhere between 0.6 and 1.2, and that can vary not only person to person but also depending on factors in each individual's life, such as various stresses and even the season of the year. Doctors are usually pretty good about taking into account things like age and weight and how manic or depressed you are to start you out on lithium, but there's really no way to tell what your kidneys and thyroid are going to do about it until the lithium hits your system. So while the therapeutic sweet spot is somewhere between 0.6 and 1.2, if you're especially sensitive to it, lithium toxicity can hit between 1.0 and 1.5! That means you can be fine and stable one day at 1.1 and wake up the next day with nausea, diarrhea, dizziness and the well-known lithium shakes. Conversely you might be fine on 900 mg of Lithobid between October and April, but come May you'll have to up it to 1,200 mg a day, just to maintain that 0.8 serum level.

Yeah, regular blood tests are part of the lithium drill. Lithium toxicity can happen at any dosage of lithium, because it all depends on how you process the lithium. Because it is processed by your kidneys you need to drink even more water than the extra water we recommend for all psychiatric drugs. Lithium is tough on your kidneys and thyroid. As long as you keep drinking water and have your serum levels checked, your kidneys are covered. Regular tests are needed to make sure your thyroid isn't getting bent out of shape.

I found out the hard way I was epileptic after starting on lithium carbonate, and was subject to rib-cracking, concussion-inducing tonic-clonic seizures for quite some time. Even though I was tested for epilepsy prior to beginning lithium treatment, but that was on rather primitive equipment back in Australia in 1985. Still, it was bad enough for me to eschew all forms of treatment for years, and then to seek treatment intermittently only for my deepest depressions. Kids, dont be like me. If one med doesnt work, try something else. I barely got out of my anti-med madness alive.
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Old 12-01-2005, 11:19 AM   #6 (permalink)
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American Airlines Sucks

American Airlines put my visibly pregnant wife and my 2 year old son (at the time) off a plane because my wife protested the flight attendents' demand that the boy in his car seat be seated apart from my wife. Morons.
A
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Old 12-01-2005, 11:34 AM   #7 (permalink)
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a couple of things for chemda...

song airlines is going away. they were a part of delta and now delta's bankrupt and can't afford nice people.

i predict that most of the shows in oregon will be hippy crowds. especially eugene.
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Old 12-01-2005, 12:33 PM   #8 (permalink)
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It was a quote.
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Old 12-01-2005, 12:37 PM   #9 (permalink)
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Quote:
Originally Posted by the big lebowski
a couple of things for chemda...

song airlines is going away. they were a part of delta and now delta's bankrupt and can't afford nice people.

i predict that most of the shows in oregon will be hippy crowds. especially eugene.
Yeah, Song (Delta) and Ted (United) are both getting reabsorbed by their parent airlines. Basically, Southwest and Jet Blue are kicking their asses.

I used to live in Portland... Ashland and Eugene are heavily hippie... other than Portland, the rest of the state is almost as redneck as the south. Oregon's funny - when it formed as a state it banned slavery but simultaneously wouldn't allow free blacks to live there. As a consequence of this blatantly racist beginning, it's lilly white.
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Old 12-01-2005, 01:15 PM   #10 (permalink)
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My girlfriend had a southern accent when we first started going out. She hated it so much that she tought herself how to not speak like an inbred. that and I made fun of how she kept saying "Fair" instead of "Fire"
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