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Dr. Nagler

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 #16 
Bill, I had no problems whatsoever withdrawing from benzodiazepines. It took me around ten days to taper under my doctor's supervision.

It has been my observation that while some individuals do indeed have difficulty getting off benzodiazepines because they develop a chemical dependence, a far greater number of those who have difficulty getting off the drugs are dependent on their effect. In other words, the source of their anxiety has not yet been effectively addressed. In my case, thanks to TRT I no longer had tinnitus-associated anxiety, which is why it was easy for me to taper.

Stephen M. Nagler, M.D.

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The best way to find yourself is to lose yourself in the service of others.
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No bird ever soared in a calm. Adversity is what lifts us.
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bill clark

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 #17 
That makes sense.  When I was taking the Clonazepam I had decreased reactivness and volume, as well as a softening of the sounds.  I'm almost convinced that my anxiety may even be creating some of the symptoms I have.  And when I'm not taking it, I'm back to square one.  So yes, I can understand being dependent on the effect.
Thanks again,
Bill
Dr. Nagler

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 #18 
In the absence of tinnitus-associated distress (e.g., the anxiety to which you refer) tinnitus is just a sound. No big deal at all. It is the distress that turns “just a sound” into “The Guest from Hell.”

Stephen M. Nagler, M.D.

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The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
bill clark

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 #19 
Hello Dr Nagler,

My question for today: How would you treat what I consider to be these unusual symptoms?
Turning my head either direction, moving my tongue side to side, bending over, stretching, and touching my scalp all produce tinnitus squeals.  Do you think anxiety could be causing this?
My Neurologist had no clue what would cause that.
The Tinnitus in my left ear which has high frequency hearing loss has 4 pitches ranging from high to highest and moves pretty continually.  My right ear has mild hearing loss and pulses with my heart beat, and the pitch mimics my left ear.  The pulsing also travels to my left ear at times.
At least 3 times every night my T wakes me up with loud high frequency squeals and pulsing.
Mayo Clinic did head and neck CT angiograms and cannot account for the pulsing.
Occasionally, the pitch frequency stays down a bit and in turn, my reactivity isn't as severe for a short time.  Otherwise, exposure to everyday sounds spike it.  I am doing what you recommended in wearing sound generators for 10 min each day when possible.  But when the frequency of my T is at the high end, the white noise is pretty unbearable.
I'm beginning to think my condition is hopeless.  When I ask I ask doctors what I might try to help, they are speechless.
I'm working with a therapist but making little progress with her CBT.  Also, I'm reading the Henry/Wilson book on coping skills.

Thank you for your time.

Bill



bill clark

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 #20 
Hello Dr Nagler,

Do you have an opinion on Biofeedback as a treatment for Tinnitus patients?


Thank you for your time.

Bill
Dr. Nagler

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 #21 
Bill wrote:

My question for today: How would you treat what I consider to be these unusual symptoms?
Turning my head either direction, moving my tongue side to side, bending over, stretching, and touching my scalp all produce tinnitus squeals.  Do you think anxiety could be causing this?

As far as I know, anxiety does not cause tinnitus. Anxiety might make you more aware of tinnitus that you already have - but anxiety does not cause it.

...............

My Neurologist had no clue what would cause that.

The question - as I see it - is one of tinnitus-induced distress and awareness (i.e., reaction and perception) rather than causation. Seems to me you are still trying to "figure out" your tinnitus. I have long been of the opinion that the first step to overcoming tinnitus is when you have finally figured out that you can't figure it out at all!

.................

The Tinnitus in my left ear which has high frequency hearing loss has 4 pitches ranging from high to highest and moves pretty continually.  My right ear has mild hearing loss and pulses with my heart beat, and the pitch mimics my left ear.  The pulsing also travels to my left ear at times.
At least 3 times every night my T wakes me up with loud high frequency squeals and pulsing.
Mayo Clinic did head and neck CT angiograms and cannot account for the pulsing.

It sounds like you have had a very thorough work-up.

..................

Occasionally, the pitch frequency stays down a bit and in turn, my reactivity isn't as severe for a short time.  Otherwise, exposure to everyday sounds spike it.  I am doing what you recommended in wearing sound generators for 10 min each day when possible.

I do not believe I made any specific recommendations at all to you in that regard. All I said is what a "typical" instruction might be. I would not want to make a specific recommendation without having evaluated you myself, and I am retired. Sorry for any confusion.

..................

But when the frequency of my T is at the high end, the white noise is pretty unbearable.

I'm beginning to think my condition is hopeless.  When I ask I ask doctors what I might try to help, they are speechless.
I'm working with a therapist but making little progress with her CBT.  Also, I'm reading the Henry/Wilson book on coping skills.

Does your cognitive behavioral therapist have much experience with people suffering from severe intrusive tinnitus?

....................

Thank you for your time.

You are welcome.

......................

Do you have an opinion on Biofeedback as a treatment for Tinnitus patients?

I am unaware of any reliable and independently verifiable controlled studies attesting to the efficacy of biofeedback in tinnitus.

Stephen M. Nagler, M.D.

__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
bill clark

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 #22 
No, my therapist has no experience working with any Tinnitus patients.  I can't find anyone who has.  I sent her Hubbard's webinar on CBT which she said was very helpful to her.
Sorry, I should have said I have been using sound generators as per what a typical instruction might be.  I saw it as a suggestion and was thankful that you brought it up.  No confusion.
And yes, there's no figuring this out.  Just when I think I've got it, it changes and my distress increases.  It' like, where is this going to end up?

As always, your help is greatly appreciated.

Bill
bill clark

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 #23 
Dr Nagler,

My question is:  Is there a reason you and your doctor chose Xanax over other longer lasting benzodiazepines when you were suffering with tinnitus distress?

I'm afraid I'll need to start meds soon if I'm going to get through this.  Bauman's book on Ototoxic drugs dedicates a section to Benzodiazepines that's a bit scarey.   I'm not concerned with the addiction but I am worried about making my tinnitus worse.  It does that on it's own.
This all started 18 years ago with "normal" tinnitus that I completely habituated to.  But the past 5 months have been bizarre.  First came the pulsing, then a number of super high frequency sounds, next was the reactivity to every day sounds, and now reactivity to normal body movements.  It seems impossible to ever adapt to or live with this condition.
Needing help and encouragement.

Thank you for your time Sir.

Bill
Dr. Nagler

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 #24 
Bill posted:

No, my therapist has no experience working with 
any Tinnitus patients.

I mean no disrespect, but that's like going to a heart surgeon for a problem with your prostate. I mean, the heart surgeon might get it right - but wouldn't you be better off with a urologist? 

.....................

I can't find anyone who has.  I sent her Hubbard's webinar on CBT which she said was very helpful to her.

Why not work directly with Dr. Hubbard then? He has many telephone and Skype patients.

....................

Is there a reason you and your doctor chose Xanax over other longer lasting benzodiazepines when you were suffering with tinnitus distress?

That was back in 1994. I suppose they recommended Xanax because the Johnson, Brummett, Schleuning study had just been published the year before, and at the time I think Xanax was sort of looked upon as the "go-to" drug for tinnitus-associated distress.

....................

I'm afraid I'll need to start meds soon if I'm going to get through this.  Bauman's book on Ototoxic drugs dedicates a section to Benzodiazepines that's a bit scarey.

Kindly tell me what it is in Bauman's background, education, training, or credentials that makes him an authority on ototoxic drugs. I'd be very interested in knowing. Thanks.

Stephen M. Nagler, M.D.



__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
bill clark

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 #25 
Dr Nagler,

I was desperate for a therapist who had a background in CBT and searched for one with experience with Tinnitus patients...but couldn't find anyone in the Minneapolis area.  I did work a couple sessions with a gal at the University of Iowa Hospitals and Clinics who is the main counselor working under Richard Tyler, but it was on the phone and even on speaker my reactivity made it a challenge.  That's why I haven't considered Hubbard.

Regarding Bauman, I know nothing about the guy other than it would take a real commitment to compile all the information he put together in that book.  And like other tinnitus sufferers, I grasp for all the information I can, and I'm sure many times what I'm reading is inaccurate.  ATA published an article from him in an issue of Tinnitus Today, the same issue your article is in, and I guess I trusted them to only publish what they consider to be reliable information.

In my eyes, you are the leading authority on Tinnitus and your opinion and advice is what I believe in and rely on.  That's why I run things by you that I've heard or read. 
And speaking of commitment, for you to take the time to help all of us who are so distressed and in need of guidance is so greatly appreciated.  And I struggle to find strong enough words to thank you enough for what you do.

Respectfully,

Bill



Dr. Nagler

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 #26 
Well, I think you should contact Bruce Hubbard and work with him.

And regarding Neil Bauman, he has no medical, audiological, or pharmacological qualifications whatsoever. His undergraduate degree was in forestry, and his doctoral degrees are in ancient astronomy and theology. He happens to be a nice guy who - as you say - has a commitment. But I'm not at all sure that makes him an authority. 

All the best -

Stephen M. Nagler, M.D.

__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
bill clark

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 #27 
Ok...I'll contact Hubbard when I can get in the right state of mind.  Currently, I'm similar to how you felt years ago...hardly able to get out of bed, just thinking of the struggles the day will bring.

I retired a couple years ago after working hard and saving for the future.  I had grand plans to spend the next years traveling with my wife and spending time with my kids and grand kids, but right now it seems that may never happen.  I can conquer tinnitus, but what is going on with me seems to be much bigger than that.  I have a lot to live for but daily suffering is getting the best of me.

Thanks again for all that you do.

Bill
Dr. Nagler

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 #28 
Bill posted:

Ok...I'll contact Hubbard when I can get in the right state of mind.

As I see it, the primary reason to work with Dr. Hubbard is to help you get in the right state of mind. Once you're in the right state of mind, you probably won't need him!  

..............

Currently, I'm similar to how you felt years ago...hardly able to get out of bed, just thinking of the struggles the day will bring.

... which is why you need help now. In my opinion, anyway.

..............

I retired a couple years ago after working hard and saving for the future.  I had grand plans to spend the next years traveling with my wife and spending time with my kids and grand kids, but right now it seems that may never happen.

... and you are going to let a sound get in the way of all that?

...............

I can conquer tinnitus, but what is going on with me seems to be much bigger than that.  I have a lot to live for but daily suffering is getting the best of me.

... which is why I suggested you begin to work with Dr. Hubbard sooner rather than later.

.................

Thanks again for all that you do.

Glad to help.

All the best with it -

Stephen M. Nagler, M.D.

__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
bill clark

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 #29 
By the right state of mind, I mean I may need to be taking meds to be able to handle the CBT sessions.  But I am so, so hesitant since I experienced the worst sound when I came off Clonazepam after only 2 days of low doses. But I don't think I'll have a choice pretty soon.  Maybe I'm being overly cautious?  I felt way better the short time I was taking it.

Thanks Dr Nagler.

Bill
Dr. Nagler

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 #30 
Quote:
Originally Posted by Bill
By the right state of mind, I mean I may need to be taking meds to be able to handle the CBT sessions.  But I am so, so hesitant since I experienced the worst sound when I came off Clonazepam after only 2 days of low doses. But I don't think I'll have a choice pretty soon.  Maybe I'm being overly cautious?  I felt way better the short time I was taking it.

Given the information you have provided here in this thread, I have told you how I think you should go about this process. I might be wrong, of course, but that's the best I can do for you.

Quote:
Thanks Dr Nagler.

You are welcome.

Stephen M. Nagler, M.D.

__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
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