Module 1: Professional Accountability and Prescribing
Case Study – Laureen’s Story
Laureen is a successful, middle-aged career woman working in banking and corporate finance. She lives alone and has never been married. A month ago she accepted a major promotion at work to oversee larger corporate files but now is noting she is not coping well. She is frank and honest about the events that have brought her to seek care. She begins with:
“About five years ago I started having trouble sleeping as my legs were irritated when I lay down and kept shaking; I was all jittery and sleep-deprived. I got a tranquilizer from a hospital outpatient doctor –5 mg Diazepam (Valium). It seemed to work great at first, but after a time not so much. My regular physician at the time called it restless leg syndrome, and recently it seems to be getting more painful, interfering more and more with my sleep and rest. Every day I take at least 2 tranquilizer pills, and two maybe three more at night to help me sleep through the entire night. If I don’t, my legs ache and twitch all the time.”
Besides the Valium for her restless leg syndrome, two years ago Laureen was also prescribed Alprazolam (Xanax) by a family physician for occasional panic attacks, a problem she has had since she was a child. In the last year she has become more reclusive, yet her panic attacks have been increasing. She can barely make it to required business dinners and after-work functions and pops a Xanax both before and during business lunches. With her new job, these events are now happening three to four times per week. Lately, she has also noticed that she has been steadily increasing her use of wine as a way to recuperate after these stressful business events and lunches. Before, she would only have a few glasses with or after dinner but now…
“….more often than not I finish off the bottle before going to bed. I just can’t seem to stop. A lot of times I will come home and tell myself that I’ll only have one glass and no more, but by the time I go to bed, the bottle is empty and I’m deciding whether I should open another or not. I never used to drink to excess or take anti-anxiety medication. Now I can’t seem to stop drinking or taking these ‘downers’ at social events. I can’t seem to control when I take them and things are happening that I’m not too happy about. I’m starting to forget if I logged data at work and I’ve lost my car keys more often than I care to mention. Of course then I have to increase my Xanax to calm my nerves when things go wrong and also take an extra Valium to make sure I get a full night’s sleep.”
After sharing this history and information, she tells you she’s been reading more about restless leg syndrome online and wonders if the tranquilizers are most of her problem or doing more harm than good. Given that when her legs begin twitching, she also experiences significant leg pain, she wonders if some strong pain medications (analgesics) might be better for her. She has a friend with the same condition who is taking OxyContin™ and he is “doing great”. She muses that it might help her cut down on wine intake if the pain was reduced. What do you think?