Have you made an appointment with your pdoc yet? I think I remember he offered to write a letter for you regarding the jury duty…

When you see him, ask him to write it explaining the meds you are taking and say you suffer from BP and a serious anxiety disorder and those things prevent you from participating in jury duty in a meaningful way. It wouldn't hurt for him to remind them of your age. My PCP sent them a letter and they excused me permanently based on the meds I take alone (I live in MA). The justice system would be overburdened with appeals if they could stipulate jurors were overmedicated at the time of trial.

It's good that you want to ask to raise the topamax, but it's a better idea to tell your pdoc everything that's been going on. You're going to get the best results if he can see the whole picture and use his education and experience to come up with the right med plan for you.

If the lunch with your nephew is going to be too much for you, you can always cancel with a polite excuse (i.e./ you're not feeling well without being specific) and tell him you hope you can see him at some point in the near future. The lunch is supposed to be a pleasant thing, not a burden.

I hope you feel better today