Snek: my daughter's withdrawal

[Gridley]

I've brought your post to the attention of the other mods so they can address your concern.  

[Snek]

Thank you, Gridley. I've been doing some more research into this and I think that it is possible she is having mild SS. She and I just talked, and she said that it was after her Fluvoxamine was increased to 100mg from 50mg that the tremor got bad (it was only slight before). This was in the beginning of January 2018. Tremor is listed as a common side effect of Fluvoxamine, and we were hoping it would go away. It did go away, but only when we reduced the Bupropion. There is no tremor now...only the GI issues and fatigue...and she has been having issues with body temperature regulation (feeling colder than she normally does - she always used to prefer the cold and now she gets chilled).

 

I am feeling so angry at the doctor who upped her dose of Fluvoxamine, and then prescribed Gabapentin to deal with the restlessness. The doctor should have noted the tremor and suspected SS instead of prescribing another drug. I so wish I knew then what I know now. I had heard about SS, but never thought she had any of the symptoms. Didn't know there could be mild unnoticed cases. Gah!

 

So now here we are. To taper more quickly or not. i have reached out to all of her doctors, but am sharing her in case anyone has any insight. Not much in the way of scientific literature except I did read that mild cases of SS can be under reported, and that mild cases can turn into life threatening cases.

 

Snek

 

 

[Snek]

Got a reply from the Psychiatrist. He hears what I am saying and understands my concern, but pointed out that her overall symptoms do not really point to SS and can can be explained by other things (in a nutshell). He's not suggesting she stop cold turkey at all, though he thinks we should address tapering the Fluvoxamine in the future. 

 

I know that people are not supposed to taper two meds at once. Does alternating med tapers count as tapering two meds at once? I mean, if she holds (and doesn't have any extra symptoms) for a month where she is with Bupropion and Gabapentin, could she then begin to taper the Fluvoxamine for a while? 

 

Thanks,

Snek

 

[Altostrata]

On 11/18/2018 at 11:33 PM, Snek said:

My fear is that I am going to keep her on a poison longer than she needs to be on it, unnecessarily. At the same time I fear that tapering too quickly will make her worse. ...

 

Our dilemma here in a nutshell.

 

As far as your own "psychiatric diagnosis": Everybody can be diagnosed with something!

 

On 11/19/2018 at 3:00 PM, Snek said:

More confusion - the pharmacist will not stand by making a liquid at home. They do not recommend cutting Bupropion, even the immediate release she is on. All of her doctors know we have been cutting this. Anyway, I am off to pick up form the compounding pharmacy now.

 

Snek

 

It's a territorial thing. Pharmacists generally do not want patients to be improvising their own drugs. We have many, many people here making their own liquids. Just ask for an oral syringe at the compounding pharmacy without the explanation. It's handy to have a 5mL and 1mL oral syringe on hand.

 

18 hours ago, Snek said:

Thank you, Gridley! One worry down...and a new worry now - 

 

I am reading about Serotonin Syndrome and worrying that my daughter has this...but I am hoping that my worry is unfounded. She does not have most of the symptoms, but she does have the nausea and she DID have the tremor before we tapered down from the Bupropion. Since the treatment for Serotonin Syndrome would be stopping her drugs cold-turkey, I would not this to be the case...but I am also worried that if she does have SS then she could be hurt more? Everything I've read says that SS occurs within hours of taking a new drug or updosing. She did not start getting nausea until after being on this drugs for around a year. The tremor began pretty soon after, though, but this was listed as a side effects of her meds. 

 

Somebody, please tell me that I am overreacting here.

 

Snek

 

This is a concern when people are taking bupropion with fluvoxamine. Your daughter has tapered buproprion to a low level where serotonin syndrome is less likely. At this point, it sounds to me like your daughter is overdosed with gabapentin.

 

I would stay the course with the gabapentin taper. Don't allow your anxiety to cause you to do things haphazardly.

 

17 hours ago, Snek said:

I am feeling so angry at the doctor who upped her dose of Fluvoxamine, and then prescribed Gabapentin to deal with the restlessness. The doctor should have noted the tremor and suspected SS instead of prescribing another drug. I so wish I knew then what I know now. I had heard about SS, but never thought she had any of the symptoms. Didn't know there could be mild unnoticed cases. Gah!

 

 

You are correct, that doctor should have known about the interaction between bupropion and fluvoxamine. He should also have been alert to signs of overstimulation from the fluvoxamine, this is a known risk of SSRIs in young people. When you have a chance, you might write a letter of complaint to the California Medical Board with a copy to the doctor.

[Snek]

Just a bit of an update - 

 

For the past week, since the day before Thanksgiving, my daughter has only experienced the slightest of occasional nausea when hungry. No vomiting. Otherwise, her only other symptom is the fatigue (which may be from her severe depression, medications, EBV, or all the above). Last night/early this morning she woke up in the middle of the night for the first time in over a week with nausea. She ate a few cookies and it went away. She is now back in bed sleeping after a rough night of insomnia. She was supposed to go to an early morning therapy meeting, but was unable to make it. I wonder if her anticipation for this meeting, and having to wake up early, contributed to her insomnia. She has her first depression group meeting tonight, and will be going to that. 

 

Not much of an update, but there it is. In 6 days she has an appointment with an out-of-network doctor who specializes in psychiatric medication and withdrawal.  

 

Snek

[Snek]

Update - 

 

Today I took my daughter to a new and highly recommended psychiatrist who specializes in antidepressant withdrawal. He believes that the Fluvoxamine is causing her symptoms (including recent weird lab work - she is beginning to suffer some serious health consequences to her immune system and thyroid at this point) and that it is important to her health to stop the Fluvoxamine. Starting tonight, she is switching from 100mg extended release to 75mg immediate release (25mg in the am, 50mg in the pm). Assuming she has no problems with this, then next week she will drop to 50mg (25mg in the am, 25mg in the pm). If she experiences any withdrawal symptoms during this taper then we will stop and take the taper more slowly. Most people seem to be able to cut their Fluvoxamine in half without real problems (it gets a LOT harder after this point). Once she is safely at 50mg for a while (a month or so), then she will begin the slow 10% per month taper. 

 

Please think good thoughts for my daughter...that she will be one of the people who are able to cut their Fluvoxamine in half over two weeks without real problems.  

 

PS She is no longer having nausea and vomiting - getting the Bupropion from the compounding pharmacy instead of cutting it up seems to have helped in this regard. 

 

Snek

[Altostrata]

Good to hear, Snek. 

 

Yes, it's true, some people are taking a dose that cause oversaturation and can make a larger initial decrease and still maintain an adequate level of the drug. If a person is suffering serious adverse effects, it can be worth it to take the risk of a larger cut and faster taper.

 

Please let us know how your daughter is doing.

[Snek]

It's been a week since my daughter cut her Fluvoxamine dose from 100mg to 75mg and so far so good (knock on wood). Nothing to report as to any changes. Tonight she cuts it to 50mg (and then we do slower 10% taper after that). I hope this goes well. What stinks is that she will also be changing manufacturers again because the previous company stopped making Fluvoxamine. I suppose that switching manufacturers at the same time as a dose change is not as bad as switching manufacturers when you're wanting to NOT change a thing. 

 

Anyway, I am SOOOOOO glad that we switched my daughter back to the Fluvoxamine instant release formula last week to begin her taper. Kaiser just informed us that the 100mg extended release is out of stock and they won't have it for several weeks! I can't imagine how stressed out I would be right now if she was relying on that particular brand/release of medication! Her old psychiatrist (who apparently did not get the memo that my daughter switched psychiatrists months ago) sent an email that basically said, 'Oh well, you can't get your Fluvoxamine...I am calling in Zoloft for you!' Never mind the fact that Zoloft was the first SSRI my daughter tried and had a bad reaction to it!

 

Some Kaiser doctors are awesome. Some...not so much. 

 

Snek

[Snek]

Nausea has returned off and on the last couple of days, and last night she had a headache. I hope that these are unrelated to the Fluvoxamine taper 4 days ago (she went from 75mg to 50mg - I know this is a large cut but it is necessary as Fluvoxamine itself is making her sick). *Fingers crossed*

 

Snek

[Snek]

Time for an update!

 

It's been a little over a month since my daughter tapered Fluvoxamine from 75mg to 50mg. Up until 4 days ago, we saw no real changes. Four days ago, nausea and vomiting returned. The last 2 days she's only been having the nausea off and on. I don't know if this is from withdrawal, the Fluvoxamine itself, or something unrelated. So frustrating.

 

At first we thought it might be a side effect of the NAC that she started a few days before becoming nauseous. Her Psychiatrist wanted her to try NAC for the intrusive thoughts that were returning as Fluvoxamine was tapered. But now it's been long enough (she stopped taking it on 4 days ago) that I don't think that it's the NAC.  

 

She is extremely irritable right now because she does not feel well and is frustrated. I am getting ready to go into her room soon to see if I can get her to go on a short walk around the block (as all the doctors she sees agree that she needs to move a little and not just stay in bed 24/7). This is not going to be easy... 

[ChessieCat]

1 hour ago, Snek said:

Four days ago, nausea and vomiting returned. The last 2 days she's only been having the nausea off and on. I don't know if this is from withdrawal, the Fluvoxamine itself, or something unrelated. So frustrating.

 

At first we thought it might be a side effect of the NAC that she started a few days before becoming nauseous. Her Psychiatrist wanted her to try NAC for the intrusive thoughts that were returning as Fluvoxamine was tapered. But now it's been long enough (she stopped taking it on 4 days ago) that I don't think that it's the NAC. 

 

From https://www.webmd.com/vitamins/ai/ingredientmono-1018/n-acetyl-cysteine

 

"It can cause nausea, vomiting, and diarrhea or constipation."

 

From https://www.rxlist.com/acetylcysteine-solution-side-effects-drug-center.htm

 

Common side effects of acetylcysteine solution include:

• nausea
• vomiting

 

The fact that it is easing seems to indicate that it may be the NAC.

[Snek]

I totally agree with you, ChessieCat! The Psychiatrist is not convinced, so I suggested that we wait until she's had no nausea for a week and then try again. She's been eating normally again since yesterday, so fingers crossed! I'd love it if NAC could help her so I'm willing to keep an open mind. Apparently it might help with the intrusive thoughts that come with OCD. Psychiatrist suggests she take it with meals next time we try. At least NAC leaves the body quickly and with no withdrawal problems...unlike certain other substances we all know about (unfortunately)!

 

  

 

 

 

 

 

 

[Snek]

Just figured I'd give a quick update - 

 

Today my daughter began taking Lamictal 12.5mg as a hopeful bridge in her Fluvoxamine taper. Now that she has cut Fluvoxamine in half, some of her OCD symptoms have gotten worse, especially the intrusive thoughts, so her doctor wants to see if Lamictal can help as we continue the Fluvoxamine taper. It's important she get off this Fluvoxamine because it appears to have been the cause of many of her health problems. 

 

Fortunately, the nausea is gone. It's only her depression and OCD that is crippling at this point.

 

Best wishes,

 

Snek 

[Altostrata]

Thanks, Snek. Please let us know how your daughter does on 12.5mg Lamictal with 50mg Luvox. At low doses, lamotrigine is a fairly benign drug, as psychiatric drugs go.

[Snek]

*Sigh*

 

She got the "Lamictal rash" and had to stop taking it. At least we knew enough to stop the drug immediately so that it did not progress to Stevens-Johnson syndrome. 

 

Looking in to Transcranial Magnetic Stimulation for "treatment resistant depression". We really want to stabilize her a little emotionally before we drop the Fluvoxamine again, yet the Fluvoxamine continues to make her sick (though nowhere near as bad as when she was on the higher dose).

 

The  roller coaster continues...

 

Attn: Altostrata 

 

 

 

 

[puthappinessfirst]

Snek,

 

You are a great mom. And your daughter is very strong. 

 

If she ever wants to talk, she can send me a message. I am only a handful of years older than her. She will get through this! 

[Snek]

puthappinessfirst, Thank you!

[Snek]

Not sure what to do - 

 

My daughter saw her out-of-network Psychiatrist yesterday. He wants her to try Memantine for OCD intrusive thoughts as she tapers from Fluvoxamine. I asked her in-network Psychiatrist for his thoughts (and a Rx if he agreed with the other psychiatrist) and he said he would not prescribe it because the studies that show it might help with intrusive thoughts are small and limited, and he is concerned about how my daughter is sensitive to drugs (which I appreciate). I am leaning toward her not trying this new drug and am hoping that out-of-network psychiatrist is not upset by this. Can anyone offer any insight as to Memantine and/or dealing with two doctors who disagree?

 

Thanks,

Snek

[puthappinessfirst]

Hi Snek,

 

Just my opinion, but adding a new med to the mix doesn't sound safe. Your daughter is, as you guys have realized, quite sensitive to meds. Heaven forbid, you try this new med and she gets an adverse reaction. Then you're dealing with her current withdrawal and then possibly adverse reactions. You definitely don't want to rock the boat.

[Snek]

puthappinessfirst

I agree with you. We're going to hold off on new meds for now...especially now that Kaiser has agreed to pay for TMS therapy! 

[puthappinessfirst]

That's great! I also want to try and get Blue Shield to cover that for me in the future. 

 

The Bay Area has a lot of great, non invasive treatments to utilize. 

[Snek]

Just a quick update - 

 

1. My daughter stopped taking Gabapentin about 3 months ago. She didn't tell me she was doing it until now. She had no ill effects from quitting the last 300mg dose. I'm glad!

 

2. TMS appears to be working (knock on wood)! Since starting 5 weeks ago, her depression score is cut in half and she is feeling a bit better. I even hear her walking around the house humming happy little songs now! Last week her boyfriend of two years suddenly broke up with her (over text! Grrr...), and I really believe that TMS is helping her cope. She believes it too. She's a little sad over the breakup, not not mores than a normal person would be. 

 

3. For the most part, her health appears to be improving. She only gets the occasional nausea now, when she is really hungry (which is normal for her) and she is not sleeping as much as she used to. She is getting out of the house more. I attribute this to TMS and cutting her meds back. Now we just need to figure out when to cut back the Fluvoxamine again...

 

Best wishes,

 

Snek

[Snek]

Quick update - 

 

My daughter did Transcranial Magnetic Stimulation (TMS) for 10 weeks. It cut her depression score in half, but it did not send her into full remission. Still, it's nice to know that something exists that can help pull her out of the deepest pit should she ever find herself in there again. Now she has mild to moderate depression, instead of severe. She no longer has any of the crazy GI issues she was having months ago. 

 

Because her thyroid tests were a little off, and her doctor wanted her to try medication for hypothyroidism anyway, we decided to try her on T3 (instead of the T4 usually prescribed - I had to advocate for this with the help of an Endocrinologist) because T3 is sometimes given off-label to treat depression. So she started taking Liothyronine (T3) 5mcg in August. The good news is that her thyroid levels are now normal. Her depression is unchanged, but this is probably due to her not being at a therapeutic dose for depression yet (which is closer to 30mcg). We are getting ready to increase her dosage. We're just taking it slow because she is so sensitive to medication.

 

On Sept. 18, she stopped taking her low dose of Bupropion. I hope that she is one of the people who suffers zero withdrawal from this. Her Psychiatrist urged this move, and my daughter really wanted to stop taking it (and she's a legal adult now) so all I can do is cross my fingers and hope. She is still on the Luvox. The plan now is to very slowly taper the luvox as she increases the T3...but we're going to wait a month for the Luvox to make sure that there are no problems with stopping the Bupropion. 

 

Best wishes to everyone!

 

Snek

[Genesis]

Snek-

 

I've just binge read your whole intro from beginning to end..  It makes me over the moon happy to hear your daughter is doing so much better!!!

 

Your username caught my attention because I use that nickname for snakes all the time  it's really cute.

 

You are such an excellent mom and she is so lucky to have you  my mom means more to me than anything, and she would do anything to make me happy.  To see that in other strong women is very endearing.  

 

You have my best wishes and I would hope you post more updates!  Congrats on both of you coming so far together, even stronger ❤️ 

 

Much love,

Genesis ❤️ 

 

Edited September 25, 2019 by ChessieCat
removed quote

[ShiningLight]

Snek,

 

So great to hear that your daughter is feeling better! Have you done independent research on TMS? I worry that it's the next fad that the psychiatric industry dishes out and I'm really concerned about that. I have been so hurt by the drugs, which are a fad (turned societal staple!) in themselves (ie Prozac on the cover of Newsweek, in 1988 or so, when I was young, depressed, and easily influenced...guess what I did after that?).

 

The thing with TMS is that it's similar to surgery in that if it messes a person up, they may be stuck with the injury going forward. I worry that your daughter is very young to be risking such an injury. I'm not so sure about how robust or responsible the FDA approval process was. I feel like a lot of pseudoscience and oversimplification is involved in TMS. And I absolutely own all of that as my own reaction. I am by no means an expert and I don't know a lot about TMS.

 

I'm very glad to hear that your daughter escaped without suffering gabapentin withdrawal. Evil, evil drug.

[Snek]

ShiningLight, I did a bunch of research into TMS and find it is a LOT safer than SSDIs and other drugs. It's been used in Europe very successfully since the 1980s...well before it was accepted by the FDA in the USA. It has a similar success rate of the SSDIs without most of the risks. The biggest risk of TMS is seizures and headaches, and I am thankful that my daughter had none of these. The change in my daughter before and after her course of TMS is like night and day. I think that the reason why it is not offered as an option before SSDIs is because it is expensive ($16,000 for six weeks). Insurance will only cover it if other treatment have been tried and failed. 

 

Of course, my daughter's PTSD and OCD are not addressed by TMS, but it really did help a lot with her depression and I am thankful for it. 

 

Snek

 

Edited September 25, 2019 by ChessieCat
unbolded

[Snek]

Genesis - Thank you so much for your lovely reply! I'm happy to hear that you have a supportive mother. As a Mom, I can't see any other way to be.

Best wishes,

 

Snek

 

Edited September 25, 2019 by ChessieCat
unbolded

[Altostrata]

18 hours ago, Snek said:

Because her thyroid tests were a little off, and her doctor wanted her to try medication for hypothyroidism anyway, we decided to try her on T3 (instead of the T4 usually prescribed - I had to advocate for this with the help of an Endocrinologist) because T3 is sometimes given off-label to treat depression. So she started taking Liothyronine (T3) 5mcg in August. The good news is that her thyroid levels are now normal. Her depression is unchanged, but this is probably due to her not being at a therapeutic dose for depression yet (which is closer to 30mcg). We are getting ready to increase her dosage. We're just taking it slow because she is so sensitive to medication.

 

I would be very careful about overdoing thyroid medication. Please review the adverse effects. Low thyroid should never be over-treated, and psychiatrists are not particularly diligent in addressing fallout from off-label use of any drug. It could be that a little T3 could go a long way, with gradual improvement over time. (Also, please be aware that women are very much overrated for thyroid issues.)

 

Snek, is your daughter seeing a therapist? It might be a good idea for her to learn non-drug techniques for managing "depression" now instead of thinking she needs drugs for it for the rest of her lift. Moodiness is common and can be normal for adolescents and teens.

[ShiningLight]

Snek,

 

I'm glad the treatment is working for her.

[Snek]

On 9/25/2019 at 1:30 PM, Altostrata said:

 

I would be very careful about overdoing thyroid medication. Please review the adverse effects. Low thyroid should never be over-treated, and psychiatrists are not particularly diligent in addressing fallout from off-label use of any drug. It could be that a little T3 could go a long way, with gradual improvement over time. (Also, please be aware that women are very much overrated for thyroid issues.)

 

Snek, is your daughter seeing a therapist? It might be a good idea for her to learn non-drug techniques for managing "depression" now instead of thinking she needs drugs for it for the rest of her lift. Moodiness is common and can be normal for adolescents and teens.

 

Altostrata - Yes, she sees a therapist and has participated in several of Kaiser's Intensive Outpatient Workshops (daily therapy for six weeks sessions) for OCD as well as depression. She's actually been in therapy since middle school. She has also taken some college level psychology courses (which she aced) and can speak on the topic on a pro level. 

 

She is taking a low level dose of the thyroid meds, and now her thyroid tests in the normal range again. She feels no better or worse for it. Nobody wants to increase her dosage at this time. 

 

What we are currently getting ready to do is begin more Fluvoxamine tapering...I'm thinking after Christmas. Kaiser Psychiatrist wants to cut her current dose of 50mg/day to 37.5mg/day (which is more conservative than the 50% cut that her non-Kaiser Psychiatrist suggested). I am pushing for 10% increments after that. So far she has gone from 150mg/day to 50mg/day with no problems. The good news is that she is no longer having that terrible nausea! She still remains sleepy throughout the day, and her depression is neither better nor worse. Her OCD is under control. The Fluvoxamine seems to be doing nothing except make her feel drugged. 

 

Stopping the Bupropion did nothing bad to her that we know about (knock on wood). The only side effect she experienced from stopping 18.75mg of Bupropion 3 months ago is that she had some psychedelic dreams that tapered off over a few weeks. She says they were great dreams, though intense. I'm thinking it was her brain reorganizing itself. 

 

We are moving to a new state in a couple of months, and she is looking forward to starting with a blank slate. I hope that the move gives her a boost. 

 

Anyone have a good Psychiatrist and/or Psychologist recommendation for the Portland/Vancouver area? Please message me if you do. 

 

Thanks,

 

Snek

 

 

[Altostrata]

Good to hear your daughter is doing well.

 

Here's a reminder: Tips for tapering off Luvox (fluvoxamine)

 

If your daughter is taking 25mg twice a day, you might ask for the prescription liquid for one of those doses, so you can taper off more gradually than a 25% reduction of her current daily dose of 50mg. Then she'd be taking 25mg in tablet form once a day and the rest in liquid form for the second dose.

[Snek]

Update:

 

After dropping to 50mg (25mg am and 25mg pm) on December 12, 2018, she dropped again 37.5mg (18.75 am and 18.75 pm) on January 20, 2020 (so a little over a year at 50mg - she just had too much going on during this time to want to try dropping again). The plan is to keep her at this dose for a few months, and then begin the 10% taper plan. So far we have not noticed any symptoms of withdrawal...except I think that she *may* be having some symptoms now (a month after her last drop). I am not sure she is having symptoms, though. Here's what's going on:

 

Last week, my daughter woke up with a fever and vomiting. The next day, other symptoms began that appeared to be the flu (very high fever, sneezing, coughing, etc). The fever suggests a virus, not withdrawal. Because my daughter has asthma, it was suggested that she take Tamiflu. I did not want to start her on Tamiflu, but I was also worrying about her dying from the flu so we had to make a decision and she tried it. After one day, she got hives and Tamiflu was discontinued. Her nausea came back at this point (it had stopped for a day) and it was believed that this was a side effect of the Tamiflu.

 

It is now four days since she stopped the Tamiflu, and although there has been no vomiting since the first day of the flu she is still getting nasty waves of nausea. Is it possible that my daughter is experiencing SSRI withdrawal at the same time she came down with the flu...a month after dropping the dose of Fluvoxamine? She is not experiencing brain zaps or anything like that - only nausea. I ask because the doctors don't think it is Tamiflu side effects anymore and do not have an explanation as to why this is happening. My daughter does have a history, however, of anxiety-induced nausea since she was a small child way before ever trying any SSRIs. She is feeling a lot of anxiety because we are in the middle of a major move (supposed to happen next week) and she is upset that the flu cost her a final week of visiting with her friends.

 

Thanks,

 

Snek

 

 

 

 

[Snek]

OMG! I just learned something simultaneously horrible and wonderful!

 

My daughter just told me that she has been lying to me (the horrible part) for the past few months every time I reminded her to take her Fluvoxamine (which I do like clockwork twice per day). She has now admitted that she stopped taking her 18.75mg Fluvoxamine since early January - cold turkey! She simply did not want to take it anymore and was not as worried about possible withdrawal effects as I was. The wonderful part is that she has had no symptoms of withdrawal in these past 3.5 months! She feels very guilty that I've been paying a compounding pharmacy for these unused pills, and I do wish she had been more honest with me (though I would have insisted she not quit cold turkey so there's that), but I can't help but feel amazingly happy that she's feeling fine after 3+ months of quitting Fluvoxamine cold turkey! I mean, her mental health has not been the best since covid (it was getting better in January and February and then her depression came back once shelter in place started), but it is no worse than it was before she tried Fluvoxamine(and even while she was taking it). I hope that it is not possible for severe withdrawal to begin nearly 4 months after stopping. 

 

Thank you all for your help during this crazy time. I hope that by sharing this story that I am not promoting that people quit cold turkey. Rather, I am hoping that this offers hope in some way for people who must quit low doses because the meds do not agree with them.

 

Best wishes to everyone.

 

Snek

[Altostrata]

That is good news, Snek.

 

There are therapists doing telemedicine now. If you like, I can give you the name of someone in San Francisco who may help your daughter with her existential fears.

[Snek]

Altostrata - Thank you! I would love to find her a therapist who can meet over phone/skype/etc. during this time of covid. If you could PM this info then I would truly appreciate it. 

 

PS - Daughter is still feeling guilty about lying to me. I said, "hey, it's like you told me that you stole money from my wallet and bought a winning lottery ticket. I'm more happy then not..."

 

Snek