GP refused me Valium for a long flight

[MinesaBottle]

DH and I are flying to Australia next week for a family funeral. I don’t cope well with flying at all, and for the last few years I’ve gone to the GP and been prescribed a few 2mg Valium for the flights (we’ve already been to NZ this year - another funeral) and last year (dsd’s wedding). Which is a way of saying I’ve taken it on long flights before with no issues. I don’t drink alcohol on flights either.

I went to the GP today to ask for some Valium or similar and she flat out refused! She said she won’t prescribe Valium for flights because ‘you won’t move around and you’ll be at risk of DVT’. How much did she think I’d take?! I’ve flown on it before and always been conscious (I can’t sleep on planes anyway) and moved around; I always get an aisle seat so I can get up. She prescribed propranolol instead; I’ve never had it and it only calms physical symptoms of anxiety, not mental ones (is what she said). I’m also worried it might interact with paroxetine; she said not but didn’t actually look it up!

Weirdly I was in tears when I got in—I think because of the disruption to my usual routine when flying. I feel like she was judging me too. But regardless, should I see a private GP (there’s one near work) and see if they would prescribe five or six Valium or similar? I need the mental calming too. I have ADHD and my thoughts race at the best of times, never mind on a long flight heading to a funeral!

You are very lucky you have a GP who can be bothered and has the time and energy to do the right thing not just the easy thing! It would have been much easier to just say you had had it before and give it again. Fortunately things change..

Thank them for their sound advice, and don’t go and get it off pushers!

YANBU as such. I can see the doctor's POV but also yours. If you really want this, and you can afford to see a private GP, then go for it. Unless you're at higher risk of DVT than the average person for some reason? In which case, the private GP might say the same. Still, could be worth a go.

then I drink a lot and take some diazepam

I sincerely hope you don't mean alcohol here. Mixing booze and benzos is beyond stupid, and something you should've been strongly advised NOT to do.

10mg of propranolol should do the trick 👍 Anxiety's a self-feeding bastard, so if you use propranolol to stop the physical symptoms, it'll starve the anxiety making it weak and vulnerable, leaving your mind totally clear and free to notice the flaws in the overblown thoughts that feed the anxiety from the other side. Then you win Think of it like a smart, targeted approach to dealing with the problem, rather than the blunt instrument of diazepam.

But if you've been given enough doses of the propranolol to do this, it might be good to try it out in advance — not to see whether it helps with the anxiety, because a) it should and b) you won't be able to tell anyway because in your everyday life you're not experiencing the same kind of anxiety, but because it can sometimes have some side effects that it's good to be aware of in advance (e.g. for me it makes me feel faint when I stand up cause I have crappy blood pressure). It's nice to be aware of how it will make you feel — sometimes people can be initially taken aback by it, because they're not used to their heartbeat being slower, for example.

Don't forget OP's never taken it before; walloping her with 40mg wouldn't exactly be helpful 😆

Incidentally, all this reluctance with benzos is totally unfamiliar to me — I think I must have a facial tattoo that's only visible to doctors that says "Shit, give this one a fuckload of sedatives".

I once went to the OOH at the hospital with anxiety and agitation, where a friend with severe anxiety had been grudgingly given 2 x 2mg diazepam a few weeks earlier, and without even asking for any drugs was given a box of 5mg tablets.

Another time, I was on a 4 x 1mg per day lorazepam dose for two weeks to handle the same thing (anxiety and agitation), was away from home on holiday, and was still anxious, so went to a walk-in centre where they gave me a couple of weeks' worth diazepam at 4 x 5mg per day. Two GPs in the room for some reason, no access to any of my records, but here, have loads of drugs.

I had 28 x 1mg lorazepam on my repeat prescription list until a few months ago — a couple of times my GP asked if I thought we should leave it on there, and when I said I didn't mind either way he just decided to let it stay, and although at my last surgery in a different part of the country I didn't have anything on repeat, all I had to do was go in and ask for something to help with anxiety and they'd give me a load or diazepam or lorazepam :-/

And when they really mean it, they give me clonazepam, but that's only if I'm actually crazy 😂

The only time I've had trouble getting hold of benzos is in hospital, where they'd started me on a drug which essentially switched off my ability to sleep, and people were yelling in distress half the bloody night, and I'd have happily given my big toes for a sleeping tablet

I don't even really like the stuff, would rather never have to take it, and am perfectly happy to go without it for years at a time… maybe that's why they give it to me. I'd much rather have the propranolol if I could!

(Obviously I told the walk-in centre doctors as much as I could, given they didn't have my notes, and they knew I was already taking lorazepam.)

As flying, even for a funeral, is optional, I can understand why drs won't prescribe, even if the risk in minuscule

These threads pop up every 6 months or so and people always claim the guidelines have recently changed. They haven’t. Many GP’s still prescribe it. And if you’ve taken it before with no problems you’re not going to suddenly go into respiratory coma and death and more than if you read the dangerous side effects of any number of common drugs - including propranolol

If you take medical advice from the internet, OP, you will get shit, dangerous advice like this. Medicine is always simple to someone with a limited understanding.

“I wonder if my friend knows this, she normally takes 20mg to get on a plane”
Yeah, thirty years ago I had some 10mg Valium from Thailand and took two before something big at the dentist. I mentioned it to the dentist to be on the safe side and she said something a bit sneering about anything under 5mg being mumbo jumbo. I told her I’d taken two 10mg tablets and she looked shocked too.

The dentist was talking bollocks anyway. We're all different. I've never felt any effect, at all, from anything equivalent to less than 5mg diazepam, even when I'd never taken it before, and it takes at least 10mg to even begin to take the edge off. Meanwhile, a 1st-degree family member whose anxiety is at least as bad as mine feels pleasantly squiffy if they takes a whole 5mg at once. I'm the same with zopiclone — need to take 2 or 3 of them.

And yet if I take even half the dose of promethazine that's recommended for adults if they're using it to get to sleep, I'm out for at least the next ten hours, and dopey all the next day.

Codeine? I get no effects other than great painkilling and some drowsiness. One of my first-degree relatives gets euphoric, while another gets zero effect from any amount of codeine (really — 60mg and it did nothing; guess they just don't metabolise it).

Admittedly, 2mg of diazepam is a very low dose and most adults, even if they're benzo-naive, won't notice any real sedation or drowsiness. But that doesn't mean it can't be having a real effect on their anxiety, on top of the fact that it allows you the security of feeling that you'll be okay because you've taken something to deal with anxiety. (I used to keep some remote-action diazepam in my handbag — I knew it was there if I really needed it, so I felt less anxious. I think after about five years rattling about in my handbag it crumbled to nothing… worked beautifully though!)

Going to the GP isn’t like going to a supermarket with a list and demanding a specific item. The GP has (with their training and modern guidelines, which change) given you their professional advice and given you appropriate treatment.

People are being really weird in this thread- calling the OP an "addict" and that she's "demanding" and "throwing her toys out of the pram" or "doctor shopping" etc.. really, really rude.

Firstly, nowhere did I see the OP "demanding" to be prescribed anything at all. She simply said she had used a low dose valium in the past and it has worked FOR HER on flights. So, when it came time to go to this funeral she went back to ask if she could use the same thing and was told no, so she is now looking at a private GP appointment. Nowhere did she say going to the doctors was like "supermarket shopping", she didnt call the GP names or insult them, she didnt demand to get what she wants, she merely asked if she was being unreasonable.
The very fact she was ASKING if her request was unreasonable clearly indicates she is open to being told yes, it is, and that proves she isn't being "demanding". She even said she was in tears when she got home because she is worrying about it. But good job for those of you who have attacked her and called her an "addict" and that she's "throwing her toys out of the pram"- good for you! What a great way to respond to someone who has admitted their anxiety has reduced them to tears and is about to attend a funeral. I hope you all feel really proud of yourselves for teaching her a damn good lesson at a time in her life when she feels low and vulnerable. Lets just hope you never feel anxious about anything in the future shall we? urgh.

@MinesaBottle - .telling someone who’s taken Valium on flights before that they’ll pass out for twelve hours and get DVT is a bit insulting

So is your complaint that she told you about the lack of reaction with other drugs 'without looking it up'.

@op I have been in exactly the same situation as you and remember how terrified I was.

I find propanalol fantastic at helping with the physical symptoms, which stops the anxiety spiral and subsequent panic attack.

I would also recommend asking for an antihistamine or looking into it - I was prescribed one and found it helpful l. I think it was lorazepam? Can't quite remember sorry.

Lorazepam is essentially diazepam but ten times as strong. Not an antihistamine.

(Diazepam being Valium)

I’m a doctor (but an anaesthetist rather than a GP). I do sometimes get patients demanding a specific type of anaesthetic. Usually because they’re friend had it or they read about it or a random stranger on the internet suggested it. And occasionally I have to explain why it wouldn’t be appropriate or suitable for them. Sometimes they’re really not happy with this but I can assure you it’s always done with the patients best interest first.

How do you demand a specific type of anaesthetic? Like a local? I do find it shocking that women are expected to have some procedures, including in theatre, with no anaesthetic at all (a friend was expected to have a hysteroscope with polyp removal with no anaesthetic at all, she hadn't realised this until she was sent to a theatre and was like, nope! Or LEETZ with no cervical anaesthetic. Loads of MNers have had their vaginas and perineums stitched after childbirth tears with no anaesthetic. There's some barbaric shit going on wrt women's pain in some areas).

Ah, hospital drugs 😍 You guys are great… I told the person sedating me for a procedure that I might need a higher dose of midazolam than usual because of my usual lack of sensitivity to benzos, and thankfully he utterly ignored me, because it turns out that injected, the normal dose works really quite well 😄 Don't remember a thing! Though the nurses were a bit perturbed that I didn't want to lie down on the bed in the recovery room, and instead got up as soon as they brought me in, and, ignoring the double vision, marched over to argue loudly with them at the nurses station that they should let me leave… (God only knows what was going on there; I'm the least confrontative person I know)

Propanolol is great. It won’t interact. Has almost zero side effects.

Benzos are old, dirty drugs to be used very short term in a CRISIS. Flying is not a fucking crisis.

NICE guidelines have changed a lot recently. And rightly so.

I told the person sedating me for a procedure that I might need a higher dose of midazolam than usual because of my usual lack of sensitivity to benzos, and thankfully he utterly ignored me, because it turns out that injected, the normal dose works really quite well 😄

Actually, some people with certain conditions often do indeed have a higher tolerance for some sedatives. My son has autism and it really takes a lot to sedate him. A colleague as well. I have complex PTSD but do know that diazepam is not good for me. But my consultant psychiatrist is aware so when I was offered it for an endoscope she was happy to contact them to let them know that's not for me.

Some people wake up from GAs more readily than others. I do! Always get told you'll be very groggy after, never am, and I'm hungry, of course, from having fasted. Although one time I woke up and forgot how to speak English. Or, I thought I was speaking English. I wasn't. It took a few hours for it to come back. That was not a pleasant experience!

All Benzos are extremely easy to become physically addicted to due to their actions the GABA receptors.

GPs are very aware of drug seeking and asking specifically for it several times in a short amount of time will have raised that red flag.

There’s plenty of other drugs to be used that do not carry the risks of Benzos.

If you fly long haul semi regularly, you need to find other coping strategies. Not just relying on Diazepam.

Without going into complex details for some patients for some procedures are a regional (such as a spinal or epidural or nerve block) vs a GA. As an Anaesthetists I’m not involved in procedures done under local
anaesthetic alone. For some operations it comes down to patient choice. However for some there’s a specific reason why one or the other is the better option - or occasionally the only practical option. That’s what I depend a lot of time discussing with patients. It can be hard when someone has been told one thing that isn’t quite correct by a non medic and then have to be told something different by myself

I'm sure he'd have squirted a bit more in there if I'd wriggled too much. (Maybe he did?) I guess that's why they use a cannula. I only had the midazolam — I've never had a general. I refuse one if possible, even if the surgeon doesn't like the idea much.

That language issue sounds alarming!

I'm autistic too; yeah, we're a bit weird with drugs. One time when I was a bit manic and refusing antipsychotics they gave me clonazepam to calm me down and it did the opposite; was climbing up to the top of playground equipment at 4am and leaping off. Not helpful… fun tho.

Oh, definitely, Stoned. My father is a huge GA risk due to heart failure, unstable hypertension (despite medication) and had his prostate removed under regional block. My late FIL had joint replacement under region block as well due to heart failure, hard to control diabetes and kidney disease.