Trazodone 2021

Quilting brings calm

I searched for trazodone postings and the last one here was several years ago.  PCP just added Trazodone 50 to LO’s medications.  Both for sleeping and as an antidepressant/anxiety aid.   LO is obsessing over a medical issue and is actively making it worse by obsessing over it, constantly showering and washing to relieve the burning. Which of course has now made things worse by drying everything out. The nurse contacted the PCP to see if additional anti anxiety medication was needed and this is what he ordered.   Does anyone have any recent experience with this medication? I agree she needs more medication. 

In addition, a biopsy of the affected area is scheduled for next week with her GYN( different practice) which I am not canceling even though the PCP and nurse think she is causing her own problem by everything she is doing.  I think the ASL nurse was a little annoyed that I wasn’t canceling it. I agree she is obsessing but PCP has never done an exam of that area.GYN has both in Oct and Jan.  I defer to the GYN about the biopsy. She does not have a UTI. 

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Quilting brings calm

Victoria. 

We’ve already tried multiple estrogen ( as in two) and hydrocortisone creams in the last 4 months to treat the irritation.   Along with Vasoline as a topical way of easing the symptoms. The biopsy is the GYNs recommendation.  She is aware of the dementia too. I may call this week and see if they want to delay it to give the Trazodone time to kick in. It’s just that LO keeps asking me to call the doctor to fix it.  The biopsy is the last hope of finding an actual cause that’s treatable. 

M1

Three comments quilting:  I kind of agree with Victoria, a biopsy is going to be very painful in and of itself.   You kind of have to think about what you would do with the results:  if there is vulvar cancer (worst case scenario), are you going to put her through excision, which is extremely painful surgery?  I'm not saying don't do it or at least have the gyn do an exam under anesthesia, but you almost need to know what the possible options are before you do the biopsy.

I'll throw another weird diagnostic possibility in there:  I've seen nickle allergy cause terrible vaginal itching, though not this late in life.  Hard to treat, because there is nickle in a lot of foods.  You might have a clue of this if she were also allergic to costume jewelry, a lot of which also contains nickle.  

Re Trazodone:  yes, good for sleep and anxiety, but can cause bad dry mouth and constipation, so watch out for those.

Keep us posted.

Quilting brings calm

M1- that is a very interesting comment.  I never knew that nickel was in food.   She may have had issues with costume jewelry. I will ask her.  Yes, she is still at an early enough stage that she should be able to answer a personal history question like that.  I understand both your and Victoria’s comments on the biopsy- I just don’t know if I can get her to quit obsessing about the issue without it.  You may remember a different post I made this week about phone calls. The ASL has ‘had it up to here’ about this issue. ( no they aren’t requesting or even suggesting we move them, director assured me this week that they are ok there - they are just as annoyed at hearing about  this issue as me.   The GYN has said it’s the next thing to consider since all the creams either didn’t help, or made it worse. 

As to mood medications- Prozac ( and then increasing it) just made her worse last year.  After a few months off, Xanax was added shortly after this obsession started in October. Was 3 times a day, reduced to two.  Seemed to help until January.   So now Trazodone.  I can’t get her to go to a geriatric psychiatrist, so PCP handling those meds. 

She has always been an anxious person.  At one time I could point to external reasons for that, but I think now it’s just her internal make-up exacerbated by the mild dementia. 

Iris L.

Atarax can be prescribed as an anti-itch medication.  Check for cognitive side effects.

I have had heavy itching in the middle of my back, under the bra strap area, for many years.  Once in a while I'll use an anti-itch cream, but mostly I just deal with it.

Jo C. posted a few times about sensory hallucinations.  You might consider this.  

Iris

Luv Power

Hi Quilting ~  I just want to add my own similar experience to help you weigh in on decisions.  Several years ago, I and home health aides noticed that Mom was rubbing her crotch and complained of pain when we assisted her with wiping after toileting.  I did the unthinkable (at the time) and did a visual exam of her peri area.  I discovered a red, angry peri area around her vulva with macerated skin.  Of course this observation happened late on a Friday afternoon.  So I consulted with a pharmacist, palliative care RN, and the homecare agency RN to implement a plan of care for more comfort over the weekend.  All agreed it was probably a yeast infection and all recommended starting over-the-counter yeast infection treatment.

However, the best advice came from the RN at Mom's PCP office when she called back on Monday morning ~ go to an OBGYN for diagnosis, telling me that the PCP does not do vulvar exams and that the yeast infection could be a result of something else at her age.  So on that advice, we went to an OBGYN for further exam and tests (weird isn't it?  checking in, waiting in the wait room and walking the halls to an exam room with much younger pregnant women!).  The OBGYN determined that she might have lichens sclerosis and/or vulvar cancer in addition to the yeast infection and prescribed an oral yeast infection treatment, estrogen cream and Desitin for relief and wait to see if it resolved the issue.

He then asked me two critical questions:  1) If not resolved with current plan of care and to determine if it was vulvar cancer, would I want to put her through the painful biopsy procedure?  And 2) if I agreed to the biopsy and it came back positive, what was the goal for treatment ~ comfort care only or aggressive treatment?  

Since you have already been to the OBGYN twice, please ask yourself those two questions and go with your heart.   This is never an easy journey and I wish you all the best whichever path you choose.

zauberflote

I am way way out of my depth here, because Mom only had garden variety itchies. She loved Tucks, the little witch hazel hemorrhoid pads. That got me thinking-- is there such a thing as lidocaine cream? Numb it right up? I hope for her sake that this can be pinned down. I am squirming just thinking about it. Poor woman!

Quilting brings calm

Luv power - until you and M1 mentioned this cancer, I had never heard of it. The GYN never even mentioned that possibility. She  just said that if the creams didn’t resolve it, a biopsy would be needed to identify what it was.  Mom is still obsessed with resolving the issue, but she won’t have thought of cancer either.  I will do some research this week.  I know what my answer would be on your second question because I see the handwriting on the wall regarding her quality of life from now in.  However, Mom ( at probably a stage 4 dementia) is still able to have coherent  ( granted very  repetitive) conversations with the doctor and they will probably go with her decision. Or my Dad will weigh in  ( I have a durable power of attorney and a medical one.  However the medical one is only if she is incapacitated.  Doctors offices ignore that if part though and are happy to discuss things directly with me on the phone). 

Z- the GYN told her to only use two additional things in addition to the prescribed creams. Vasoline or Aquafor.  She told her not to use wipes ( like baby wipes) because they contained perfumes etc that could be irritating.  Last week the GYNs’ nurse said she could try coconut oil.  However that was an immediate no after the first use. 

Luv Power

Please keep us updated.  Sending love and strength to you on our path to this never easy journey.

Iris L.

Sitz baths with plain water or an approved additive may help with itching.  

Iris

SunnyBeBe

Was she tested for vaginal yeast infection?  Lots of bathing and cleaning can cause it and nothing helps it but an anti fungal. A cream and pills would help really quick if that is the culprit.  They can drive you crazy with the itching.

Quilting brings calm

Update on  trazodone.  LO evening phone voice sounds louder ( now normal volume) and more confident.  Her in person demeanor not so much. 

Other: had the biopsy today. GYN thinks it is just dry irritated external skin, but feels bad that she hasn’t solved the problem.  Will refer her to a specialist ( thought she was a specialist? ).  The GYN said enough times that she didn’t feel there were cell changes that I’m pretty sure she’s not thinking cancer. 

I felt bad after this appointment because I had to contradict my Moms’  version of things to the doctor a few times. Mom is fixated on the issue and the steps she takes to relieve it( multiple showers per day. Lots of Vasoline, lots of complaints to the nurses at the ASL and to me) .. yet she denied it all to the doctor and said she wasn’t doing any of that - just taking 1 shower a day and using Vasoline once a day. She wasn’t as anxious today because her repetitiveness was once  every few minutes rather than constant.  So the Trazodone mat be helping ... or not: