Chapter Eleven

To Drug or not to Drug

July 2, 2002

Dear Dr. Saunders,

This note is to let you know how Lee is doing on the Zyprexa and Klonapin, and to ask if you would like to change anything.

After his release from the hospital in mid May, he was instructed to take 2.5mg twice daily of Zyprexa and .5 mg of Klonapin. We adhered to this regimen until June 6 when you recommended that, because of a rash he had, we suspend these until you saw him on June 10. During this prior period of time, he was rational but I thought he was very subdued and “drugged.” During the four days these drugs were withheld, he became much more alert and animated, as you noticed when you interviewed him on June 10. I noted that he had been sleeping quite well, but during the suspended time, he had not been sleeping well. “Twitchy,” as I call it.

You recommended that he go back on the two drugs at the same dosage, but one at a time. We chose the Zyprexa first, and I noticed that he again became “drugged” and continued to not sleep well. We then stopped the Zyprexa and restarted the Klonapin at .5mg in the evening. This was so we would know what to blame if the rashes started again. He went back to sleeping well again and became more alert.

About ten days ago we started the Zyprexa again, but only 2.5mg in the evening. He has again become somewhat subdued and almost “drug stupid” on occasion when he has taken the medication in the afternoon instead of the evening. I should elaborate by explaining that he is functioning well and is not a zombie, but there is a noticeable difference when he is taking Zyprexa.

My concerns are: that he might be over-medicated and that this is causing his sluggishness, but that stopping the Zyprexa may eliminate long-term benefits of this drug; and that is he continues on the Zyprexa, his drugged state may adversely affect his evaluation in October at UCSF Memory and Aging Clinic.

Do you have any recommendations or shall we continue as we are?

Thanks,

Bronwyn Swift

Message rec’d July 23, 2002

Dr. Saunders called and recommended that Lee stop taking Zyprexa. Resume if he becomes agitated or irritable.