Nobody in my clinic had heard of doing it this way

Started 16 July 2024 · 24 replies · 296 hearts · read 4.1k times

DoraUtrecht, NL · 16 July 2024

2 years ago

Starting a thread on this because it keeps coming up in ones and twos: Nobody in my clinic had heard of doing it this way

I have been reading here for a few weeks and have not posted, so this is me posting.

I have read the guides here, which were more useful than anything else I have found, and I still have a question about the timing that they do not cover.

What I am trying to work out is whether this is a phase with an end to it or the shape of things now, and I do not think I can tell that from inside it.

No rush on replies. I am not going anywhere and neither, apparently, is this stage.

BrammyBelfast, NI

I do not think going slowly is universally better. I think it was better for me, and I am very cautious about turning my experience into anybody's rule.

GwendaEbbw Vale, UK

I went back down a step once, deliberately, and it was not a failure. It was the most sensible fortnight of the year and my prescriber agreed without hesitation.

GwynethAberdare, UK

I hold at a step for as long as it is still teaching me something. When a step gets boring, that is usually my sign to talk about the next one.

14me too 2

TomásFacilitatorLisbon, Portugal

Something worth noticing whenever it happens in a thread like this: somebody puts down the difficult version rather than the tidy one, and nobody flinches. That is not automatic and it is most of what we are for.

IdrisCardiff, UK

This is the post I wish had existed when I was looking for it.

BroganCumbernauld, UK

Building on what Gwyneth wrote rather than answering the original question.

The thing that finally let me relax was realising that staying put is an active choice with a reason behind it, not a lack of a decision.

GwennoPwllheli, UK

I found I needed about three weeks at each step before I knew what that step was like. Two weeks always gave me a half-formed impression that I then acted on.

BevanSwansea, UK

Somebody in this circle described their pace as "geological" and I have thought about that phrase very fondly ever since. Mine is similar and nobody minds.

9me too 5

HeddaCopenhagen, DK

My step-ups are all in April and October now, entirely because those are quiet months in my working year. That is a completely legitimate way to plan it.

9me too 8

HalCambridge, UK

#10

Gwenno, thank you for that. It gives me somewhere to start from.

Whenever somebody new arrives worried about being slow, I say the same thing: nobody in this circle is going to be impressed by speed, and nobody is keeping score.

DoraUtrecht, NL

#11

I would gently add that slow is not the same as stalled. I moved twice this year, both times deliberately, both times after a conversation. That is progress with a handbrake, not no progress.

BrammyBelfast, NI

#12

Coming back a year later to say the slow route held. I am still on treatment, still comfortable, still having ordinary weeks. That was the entire point of going slowly.

GwendaEbbw Vale, UK

#13

I have been at the same step for eleven months, agreed with my prescriber, and it is the best decision I have made in this whole business. Slow was not a compromise, it was the plan.

6me too 6

GwynethAberdare, UK

#14

Picking up Brammy’s point rather than starting a new one.

The schedule on the box is a default, not a deadline. My nurse said that in my second month and it reorganised how I thought about the whole thing.

FlorrieBlackburn, UK

#15

Gwyneth — yes, and the bit that took me longest to accept was the next part.

The thing that changed my mind about pace was noticing that my worst fortnights all followed a step-up I had not really been ready for. That pattern was in my own notes.

IdrisCardiff, UK

#16

Nine months at one step here and my prescriber has never once suggested moving. She said the schedule is a scaffold and I am not obliged to climb it.

BroganCumbernauld, UK

#17

You have described the bit that nobody warns you about.

GwennoPwllheli, UK

#18

Going up slowly meant I could actually tell what each change did. When I moved faster at the start, everything happened at once and I could not attribute anything to anything.

10me too 2

BevanSwansea, UK

#19

A practical note: I keep a single line per step with the date I started it and the date anything settled. It is the most useful piece of paper I own for these conversations.

12me too 7

HeddaCopenhagen, DK

#20

Gwenno said something I want to sit with for a second.

Somebody asked me whether slow titration is just fear management, and honestly, partly. It is also symptom management and life management, and I have stopped ranking those.

HalCambridge, UK

#21

Bevan — yes, and the bit that took me longest to accept was the next part.

I stayed where I was for four months because it suited me there, and the only pressure to move came from me. Not from my prescriber, and certainly not from anybody here.

DoraUtrecht, NL

#22

What worked for me was agreeing a review point rather than a step-up date. We would look at it in eight weeks and decide then, which took the whole thing out of my head in the meantime.

TomásFacilitatorLisbon, Portugal

#23

A note for whoever opened this, whether you are still reading or come back to it in a year: there is no obligation on you to update us, and equally you are always welcome to.

GwendaEbbw Vale, UK

#24

Hal, thank you for that. It gives me somewhere to start from.

Slow titration is not the cautious version of this. For some of us it is simply the version that works, and I have stopped framing it as a hedge.

12me too 5