Natural substances treat depression (and bipolar), parentheses and contents added by me, story on KSL.com, it looks like some study results released today by the University of Utah on two natural substances the body makes or uses; they say creatine is in every cell in the body, and uradine is usually found in breast milk.
The story leads me to feel that these sound really promising, especially since they treated adolescents (granted, I'm not one of those) with bipolar with uradine alone, even, after having treated them with these as supplements to the regular medication.
I'm so excited about this I had to post it before going to bed, staying up a little late but I'm too excited even though it'll be years before this makes it to approval, if it does, for use for people like me. Hopefully there's alot fewer side effects with things like this than with current medications.
Monday, November 29, 2010
Saturday, October 16, 2010
"Your boots have decayed because of scurvy."
Bwa ha ha haha.
My husband was playing a free online pirate MMO that he likes, and they incorporate item decay into the game. When something decays, it pops up a message with a reason for the decay, although he complains that things decay too fast.
Well, as the post title says, he got a particularly ridiculous reason for his virtual nautical boots to decay, and I just couldn't help but post the absurdity of it here for your amusement . . . . .
Should you ever find yourself in a scurvious (not a word, heh) situation, please watch out for your footwear!
Oh yes, he also became suitably nervous for his ship's welfare when he dredged up a treasure chest that contained, among other things, a Kraken-Repellant Necklace . . . . .
My husband was playing a free online pirate MMO that he likes, and they incorporate item decay into the game. When something decays, it pops up a message with a reason for the decay, although he complains that things decay too fast.
Well, as the post title says, he got a particularly ridiculous reason for his virtual nautical boots to decay, and I just couldn't help but post the absurdity of it here for your amusement . . . . .
Should you ever find yourself in a scurvious (not a word, heh) situation, please watch out for your footwear!
Oh yes, he also became suitably nervous for his ship's welfare when he dredged up a treasure chest that contained, among other things, a Kraken-Repellant Necklace . . . . .
Wednesday, July 21, 2010
I Wrote Myself a Letter Incorrectly
Well, so I've been working on heavy material from my childhood in therapy, recently.
I was supposed to write a letter to myself - a letter, to my younger self.
Apparently it was a bit too . . . intellectual, not that he outright criticized it like that; he was more kindly about it. He said I read it out very . . . emotionlessly, which I agreed with, and we talked further about why that might be, and the issue of the letter being written from too intellectual a point a view came up.
The letter was too "safe". Me, I'm really good at running from my emotions. It's no surprise that this first attempt at addressing a difficult, emotional subject should have ended up rather timid and safe.
So, my homework is, after listening to the two most recent sessions of therapy again, is to write another letter to my younger self, this time talking more about the stuff that those mean kids did to me when I was young. This is hard and painful for me, but if I'm going to heal, I need to deal with it.
This sucks. It's been difficult to re-hear myself breaking down and sobbing in these particular sessions of therapy; sometimes therapy is alot easier to listen to than this. These ones are definitely NOT easy for me to listen to, but I'll get through them. It IS cleansing and healing, especially since I am hearing things that didn't come through the sobbing clearly at the time.
I just don't know how I am going to handle life when therapy is suddenly cut off with the insurance ending; I'm going to feel like an arm or leg has been torn away. I feel like therapy is essential for me at this point in my life, and that I can't do without it, but I'm going to have to figure out how to stuff things back inside for awhile without exploding. I don't know how I'm going to do that, because I'm kind of volatile right now.
I was supposed to write a letter to myself - a letter, to my younger self.
Apparently it was a bit too . . . intellectual, not that he outright criticized it like that; he was more kindly about it. He said I read it out very . . . emotionlessly, which I agreed with, and we talked further about why that might be, and the issue of the letter being written from too intellectual a point a view came up.
The letter was too "safe". Me, I'm really good at running from my emotions. It's no surprise that this first attempt at addressing a difficult, emotional subject should have ended up rather timid and safe.
So, my homework is, after listening to the two most recent sessions of therapy again, is to write another letter to my younger self, this time talking more about the stuff that those mean kids did to me when I was young. This is hard and painful for me, but if I'm going to heal, I need to deal with it.
This sucks. It's been difficult to re-hear myself breaking down and sobbing in these particular sessions of therapy; sometimes therapy is alot easier to listen to than this. These ones are definitely NOT easy for me to listen to, but I'll get through them. It IS cleansing and healing, especially since I am hearing things that didn't come through the sobbing clearly at the time.
I just don't know how I am going to handle life when therapy is suddenly cut off with the insurance ending; I'm going to feel like an arm or leg has been torn away. I feel like therapy is essential for me at this point in my life, and that I can't do without it, but I'm going to have to figure out how to stuff things back inside for awhile without exploding. I don't know how I'm going to do that, because I'm kind of volatile right now.
Thursday, July 08, 2010
In Which the Psychiatrist is Late, & Initially Very Confusing
My psychiatrist was twenty minutes late today, which means that she got in to the office at 9:20, which was when she was supposed to see ME, but her FIRST appointment, her 9:00, was still waiting to be seen, so I had to wait longer. UGH!! She said, "I'm sorry I'm so late!!", and the other patient said, "Don't worry about it", but I said absolutely nothing . . . . . lol.
Can you tell I was a little peeved? In early morning traffic, it takes about 35 minutes to get there, so we had gotten up early, and had gotten there 10 minutes early, even, not wanting to shave it right to the minute.
I suppose everyone has an off day, though. It's still annoying for me, as the patient! Guess I wasn't very "patient", heh.
While I waited, just after the first patient went in, a pair of drug reps, one in training, came in, and dropped off some samples in her back room, then sat down to wait. I vowed that I'd get seen before them, because patients are more important.
They talked alot of business, and about where each of them had worked, and some of the details of the software they were using on the laptop, that they wish they'd had at the previous place, and stuff. It was interesting to listen to them talk.
Drug reps are a sadly necessary "evil" of the medical practice, because they provide drug samples for the doctors, without which you wouldn't be able to start some of the initial doses of certain medications, and sometimes the samples are used to help some patients afford the medications, although they do NOT replace the pharmacy, not at ALL. The drug reps also provide coupons and promotions for the patients to redeem for free two week or one month supplies of the medication, with prescription, at the pharmacy, whenever their companies are offering such coupons and promotions, so again, these things are good for the patient's pocketbook, their bottom line, for being able to afford the medications, when the insurance situation isn't ideal. Obviously some of these don't last very long, while other programs will, say, take half off the cost of the medication for a year, but whatever can help the patient, is a GOOD thing.
It's just, the whole salesman aspect of the thing, seems a little . . . smarmy. It also feels a bit intrusive, to have salesmen in the medical setting like that, but as I say, it is a necessary "evil", even if one wonders about the influence that they may have over a doctor's prescribing practices. The most ethical doctors will not be influenced, but no one is perfect.
Anyway, sitting there for awhile, listening to them, I didn't think they worked for Pfizer, the makers of Geodon, the medication I had been reduced in dose after my recent bad experience on, and was here today to be likely removed off of and put on possibly something else, but if they did, I wanted to tell them I thought it sucked. So, I asked them eventually, "Do you work for Pfizer?" They said, "No", so I continued anyway, since they'd still have an interest, and they did, and I said, "Well, Geodon sucks". They said, "We think so too, we sell a competing product." I said "Oh, okay. I hate it, because I had unexpected side effects." They then expressed their regrets to me that I'd had a hard time, and again said that they didn't like the med.
I thought the whole interaction was a little bit funny, hee. Normally I wouldn't, as a patient, have any kind of interaction with drug reps at all, but since my psychiatrist was late, and since they'd been chatting for awhile so freely in front of my husband, daughter and I in the waiting room (after all, this is the type of location that is basically their workspace for the whole day; that, and their car, so one can't expect them to just sit there silently), so their chatting had encouraged me to eventually strike up a conversation, since there was nothing else to do while I waited for the doctor.
When she eventually came out, as she walked past them to the front desk, she asked them if she needed to sign something, (I assume as in, to sign for the samples they'd dropped off in her back room) and they stood up and handed her a clipboard and started talking with her, the one in training did. I wondered if he'd bring up with her anything about the competing product for Geodon, since he knew she'd be bringing me off of that one, and potentially on something else, but it seems they had enough discretion NOT to go there, which amazed me slightly, for salesmen. They just brought up the coupons and promotions that are so helpful for patients, and got the signed clipboard back, and in the middle of signing it, she called me in to the office, which helped let the drug reps know that she'd not be spending a lot of time with them, and made me feel like I was her priority. I didn't feel badly that she'd signed for the samples, because otherwise these men would just be sitting around for another 25 minutes doing nothing, when just 2 minutes of her time took care of the whole matter.
So, the appointment starts, and I'm not sure how we get started talking about body issues, except for maybe I mention the weight loss and the fact that my knees have been hurting more than usual lately. She then starts in with, "Well, what has your body done for you your whole life?"
I'm like, "What??" She repeats, "What has your body done for you, ever since you were born, ever since you were a child, what has it been doing for you?"
I stammer out something like, "Well, it exists . . . . "
She repeats the question. I am completely confused. I start talking about how lately it sucks with the arthritis diagnosis but that's not really what she means. As far as the face goes, I start getting emotional and talk about how, for most of my life (and then I amend that, to up through the end of high school), I had a HUGE overbite. It was so bad, I was in braces a lot, although the first orthodontist was an idiot, because when we moved to Utah, the orthodontist here took one look at my face and knew that, while I'd need braces, they would be in preparation for jaw surgery, because my jaws were mis-aligned; ie, I'd been born that way, and they'd need to be broken and moved and reset to be fixed. But, preparatory to that, I'd need about 2 years of braces first, to get the teeth lined up first, since what the first orthodontist had done had been ineffectual, and NOT with surgery in mind as the end-game.
So, I began the two years of braces, and then in the spring of my senior year of high school, I had jaw surgery, that changed my face a good bit. They broke both jaws. They moved the upper one down and farther back in, and moved the lower one up and forward. This changed my nasal cavity and nose a little bit as a result, though they didn't break the nose at all, but the upper jaw was changed in a way that it was broken behind the nose, if you get what I'm saying. This made breathing after surgery a bit hairy, since everything was swollen up, and my jaws were wired shut. I sounded like Darth Vader, breathing through my teeth.
Anyway, in January of my senior year in high school, I had been having suicidal thoughts and had broken down and told my parents, and said, "I need counseling, psychological help. I need help, mom, dad." So I got help through LDS Social Services, where a psychiatrist put me on Prozac, and a counselor started seeing me once a week. As the surgery approached, though, I started getting nervous about all the "issues" involved with changing my face, and I was not sophisticated enough, in hindsight, to deal with them at the time, so I never resumed counseling nor the Prozac (at that time, on the med), after I had the surgery, because I was afraid of all the issues involved with the whole changing of my face. It was a VERY complicated and EMOTIONAL issue, because ever since I was TINY, I had been called a BUCK-TOOTHED BEAVER, and all sorts of horrible names, by other children whilst growing up. I had been ostracized, I had had stuff thrown at me, I had been "pretend kidnapped", I had had to walk the gauntlet of the bus every day where kids would slam books down on my head, throw stuff at me, spit spit balls . . . . I had had other kids spit in my face, which is a dehumanizing thing that NO ONE should have to suffer . . . . I had been beaten up TWICE on the way home from junior high school, which I can still see vividly . . . I had been WHIPPED, in elementary school, with one of those jump ropes that have the plastic thingies on, well, you don't know pain until you've been whipped with one of these, the military should employ them, it was that painful. That whip was one of the few times I couldn't keep the tears off my face coming back in from recess, and so the teacher sent me to the principal and I had to tell what happened. You NEVER tell what happens, not EVER. But that one was beyond my physical limits to contain, so I paid for that one.
All because of my stupid FACE.
So you want to know what my body has done for me? Bloody NOTHING, that is what my body has done for me!
Not what she wanted to hear, lol. This isn't what we got to, we ended up starting at the toes, and starting to work our way up, we only got to the feet, and settled on mindful walking, as a way to start taking care of my body.
It was partway into this discussion that I decided that this confusing discussion wasn't any harmful New Agey crap and was really just mindfulness, which IS a helpful tool, because I tend to, with my anxieties, live too much in the future, and not enough in the PRESENT. I DO believe that the mind and body can have a powerful connection, so I decided to be more open-minded and get "into" the discussion, so I settled into the groove and began to get something out of what we were discussing.
After talking about mindful walking, which involves concentrating on the feet, and their surroundings, and the sensations involved in walking, and such, we finally got to talking about the medications, through a really clever segueway on my part, heh.
We'll be discontinuing the Geodon, and thus discontinuing the lorazepam which has only been on an as-needed basis, but OH how I've been on the "edge" of freaking out, or getting "agitated", about many things, on the Geodon; this is one of the reported side effects of the medication that has been driving me BATTY! I've only taken the lorazepam about 4 times, as I only felt it got extreme that many times, but . . . UGH. I'll be chucking this benzodiazepine, as I'll be resuming my old one, the clonazepam, for taking care of the odd things I do in my sleep sometimes. This should also help take care of the getting me to sleep thing, that the Geodon had been making me sleepy. As painful as my legs can be, getting sleep can be an issue if I don't have an additional aid, so I'm glad to have one. I know as my recovery continues that that won't always be the case, ie, that if I didn't do odd things in my sleep, I wouldn't need the Clonazepam, that I'd be able to get to sleep on my own, that it is for the odd things in my sleep, but for now, while my legs are painful, the additional effect of it making me sleepy is a handy additional side effect, that I bless it for.
The replacement for the Geodon is . . . the medication that she'd lowered that caused her to want to add Geodon in the first place. She'd lowered my topirimate from 150mg a day to 100, and I'd reported feeling less stable on it. Thus, she'd added a more traditional mood stabilizer. She's not the psychiatrist who had initially prescribed topamax, now topirimate as generic, for mood stabilizing as an off-label use, and so I hadn't thought she'd be up for raising it back up. But she said that, "You know how you feel, you know what had been working, and how it felt when it was lowered, so we'll go back up." Or something like that. I'm guessing that after the last couple years of my having been tried on a couple different things, that the stable of mood stabilizers is getting down to things that would potentially cause a raise in blood sugar and/or even diabetes, which, for someone at my (yes, it's reduced, but still not a great weight for this) weight of 225-235 and 5 foot 7", is not the best idea.
So, I apologize for the long post, but there you have today's experience at the psychiatrist's office, with a little back history on the face. It's funny how the knee surgeries have brought up all the old issues with the face again, obviously I need to spend some time in therapy working through the face-changing issues that I never worked through at age 18. Working through all the baggage from growing up with the face that I was born with, which I'm sure my parents would say wasn't a bad face, but of course I couldn't get that surgery fast enough. I went through the equivalent of torture, in my young life. Both emotional, and physical. It's probably why I developed mental illnesses, in the first place, although maybe some was in the DNA, since my 2nd oldest brother also has ADD. I've read that untreated ADD can lead to developing bipolar, but there's no blame to my parents, because they didn't know about such things back then, and even when they did, it was more recognized in boys, than in girls. But it certainly wasn' t recognized in the 70's and early 80's, in girls. And who'd have had a clue about anxiety disorders, either? I'm pretty certain that I had THOSE before I was even 13, just thinking about how I was, but when you think about having to worry about being hit by a book or other stuff every day getting on the bus, you get battle weary pretty quick.
That phrase makes me wonder about PTSD . . . . like I need something else, anyway.
Nowadays if some kid was "pretend kidnapped" like me and my brother were, the two kids responsible for it, they were teenagers, they'd be arrested as juvies, for the circumstances and actions I remember. They seriously would be, nowadays. For treating us the way they did, burying us in leaves, taking us against our will, holding us against our will, telling us they'd kill us if we left, burying us until it was dark under the leaves, and saying they'd kill us until we were dead (the boys involved were 14 and 15, or 16, I believe, we were 11 and 12, I think) . . . . I can't remember how long we laid there, but it was a LONG time. They hauled us over a block, into the woods, against our will, and stood guard over us for awhile. I believe our parents spoke to the parents of one of the boys, but I can't remember, I was just terrified out of my skull. I never jumped in a leaf pile again, after that. Can't stand them.
Can you tell I was a little peeved? In early morning traffic, it takes about 35 minutes to get there, so we had gotten up early, and had gotten there 10 minutes early, even, not wanting to shave it right to the minute.
I suppose everyone has an off day, though. It's still annoying for me, as the patient! Guess I wasn't very "patient", heh.
While I waited, just after the first patient went in, a pair of drug reps, one in training, came in, and dropped off some samples in her back room, then sat down to wait. I vowed that I'd get seen before them, because patients are more important.
They talked alot of business, and about where each of them had worked, and some of the details of the software they were using on the laptop, that they wish they'd had at the previous place, and stuff. It was interesting to listen to them talk.
Drug reps are a sadly necessary "evil" of the medical practice, because they provide drug samples for the doctors, without which you wouldn't be able to start some of the initial doses of certain medications, and sometimes the samples are used to help some patients afford the medications, although they do NOT replace the pharmacy, not at ALL. The drug reps also provide coupons and promotions for the patients to redeem for free two week or one month supplies of the medication, with prescription, at the pharmacy, whenever their companies are offering such coupons and promotions, so again, these things are good for the patient's pocketbook, their bottom line, for being able to afford the medications, when the insurance situation isn't ideal. Obviously some of these don't last very long, while other programs will, say, take half off the cost of the medication for a year, but whatever can help the patient, is a GOOD thing.
It's just, the whole salesman aspect of the thing, seems a little . . . smarmy. It also feels a bit intrusive, to have salesmen in the medical setting like that, but as I say, it is a necessary "evil", even if one wonders about the influence that they may have over a doctor's prescribing practices. The most ethical doctors will not be influenced, but no one is perfect.
Anyway, sitting there for awhile, listening to them, I didn't think they worked for Pfizer, the makers of Geodon, the medication I had been reduced in dose after my recent bad experience on, and was here today to be likely removed off of and put on possibly something else, but if they did, I wanted to tell them I thought it sucked. So, I asked them eventually, "Do you work for Pfizer?" They said, "No", so I continued anyway, since they'd still have an interest, and they did, and I said, "Well, Geodon sucks". They said, "We think so too, we sell a competing product." I said "Oh, okay. I hate it, because I had unexpected side effects." They then expressed their regrets to me that I'd had a hard time, and again said that they didn't like the med.
I thought the whole interaction was a little bit funny, hee. Normally I wouldn't, as a patient, have any kind of interaction with drug reps at all, but since my psychiatrist was late, and since they'd been chatting for awhile so freely in front of my husband, daughter and I in the waiting room (after all, this is the type of location that is basically their workspace for the whole day; that, and their car, so one can't expect them to just sit there silently), so their chatting had encouraged me to eventually strike up a conversation, since there was nothing else to do while I waited for the doctor.
When she eventually came out, as she walked past them to the front desk, she asked them if she needed to sign something, (I assume as in, to sign for the samples they'd dropped off in her back room) and they stood up and handed her a clipboard and started talking with her, the one in training did. I wondered if he'd bring up with her anything about the competing product for Geodon, since he knew she'd be bringing me off of that one, and potentially on something else, but it seems they had enough discretion NOT to go there, which amazed me slightly, for salesmen. They just brought up the coupons and promotions that are so helpful for patients, and got the signed clipboard back, and in the middle of signing it, she called me in to the office, which helped let the drug reps know that she'd not be spending a lot of time with them, and made me feel like I was her priority. I didn't feel badly that she'd signed for the samples, because otherwise these men would just be sitting around for another 25 minutes doing nothing, when just 2 minutes of her time took care of the whole matter.
So, the appointment starts, and I'm not sure how we get started talking about body issues, except for maybe I mention the weight loss and the fact that my knees have been hurting more than usual lately. She then starts in with, "Well, what has your body done for you your whole life?"
I'm like, "What??" She repeats, "What has your body done for you, ever since you were born, ever since you were a child, what has it been doing for you?"
I stammer out something like, "Well, it exists . . . . "
She repeats the question. I am completely confused. I start talking about how lately it sucks with the arthritis diagnosis but that's not really what she means. As far as the face goes, I start getting emotional and talk about how, for most of my life (and then I amend that, to up through the end of high school), I had a HUGE overbite. It was so bad, I was in braces a lot, although the first orthodontist was an idiot, because when we moved to Utah, the orthodontist here took one look at my face and knew that, while I'd need braces, they would be in preparation for jaw surgery, because my jaws were mis-aligned; ie, I'd been born that way, and they'd need to be broken and moved and reset to be fixed. But, preparatory to that, I'd need about 2 years of braces first, to get the teeth lined up first, since what the first orthodontist had done had been ineffectual, and NOT with surgery in mind as the end-game.
So, I began the two years of braces, and then in the spring of my senior year of high school, I had jaw surgery, that changed my face a good bit. They broke both jaws. They moved the upper one down and farther back in, and moved the lower one up and forward. This changed my nasal cavity and nose a little bit as a result, though they didn't break the nose at all, but the upper jaw was changed in a way that it was broken behind the nose, if you get what I'm saying. This made breathing after surgery a bit hairy, since everything was swollen up, and my jaws were wired shut. I sounded like Darth Vader, breathing through my teeth.
Anyway, in January of my senior year in high school, I had been having suicidal thoughts and had broken down and told my parents, and said, "I need counseling, psychological help. I need help, mom, dad." So I got help through LDS Social Services, where a psychiatrist put me on Prozac, and a counselor started seeing me once a week. As the surgery approached, though, I started getting nervous about all the "issues" involved with changing my face, and I was not sophisticated enough, in hindsight, to deal with them at the time, so I never resumed counseling nor the Prozac (at that time, on the med), after I had the surgery, because I was afraid of all the issues involved with the whole changing of my face. It was a VERY complicated and EMOTIONAL issue, because ever since I was TINY, I had been called a BUCK-TOOTHED BEAVER, and all sorts of horrible names, by other children whilst growing up. I had been ostracized, I had had stuff thrown at me, I had been "pretend kidnapped", I had had to walk the gauntlet of the bus every day where kids would slam books down on my head, throw stuff at me, spit spit balls . . . . I had had other kids spit in my face, which is a dehumanizing thing that NO ONE should have to suffer . . . . I had been beaten up TWICE on the way home from junior high school, which I can still see vividly . . . I had been WHIPPED, in elementary school, with one of those jump ropes that have the plastic thingies on, well, you don't know pain until you've been whipped with one of these, the military should employ them, it was that painful. That whip was one of the few times I couldn't keep the tears off my face coming back in from recess, and so the teacher sent me to the principal and I had to tell what happened. You NEVER tell what happens, not EVER. But that one was beyond my physical limits to contain, so I paid for that one.
All because of my stupid FACE.
So you want to know what my body has done for me? Bloody NOTHING, that is what my body has done for me!
Not what she wanted to hear, lol. This isn't what we got to, we ended up starting at the toes, and starting to work our way up, we only got to the feet, and settled on mindful walking, as a way to start taking care of my body.
It was partway into this discussion that I decided that this confusing discussion wasn't any harmful New Agey crap and was really just mindfulness, which IS a helpful tool, because I tend to, with my anxieties, live too much in the future, and not enough in the PRESENT. I DO believe that the mind and body can have a powerful connection, so I decided to be more open-minded and get "into" the discussion, so I settled into the groove and began to get something out of what we were discussing.
After talking about mindful walking, which involves concentrating on the feet, and their surroundings, and the sensations involved in walking, and such, we finally got to talking about the medications, through a really clever segueway on my part, heh.
We'll be discontinuing the Geodon, and thus discontinuing the lorazepam which has only been on an as-needed basis, but OH how I've been on the "edge" of freaking out, or getting "agitated", about many things, on the Geodon; this is one of the reported side effects of the medication that has been driving me BATTY! I've only taken the lorazepam about 4 times, as I only felt it got extreme that many times, but . . . UGH. I'll be chucking this benzodiazepine, as I'll be resuming my old one, the clonazepam, for taking care of the odd things I do in my sleep sometimes. This should also help take care of the getting me to sleep thing, that the Geodon had been making me sleepy. As painful as my legs can be, getting sleep can be an issue if I don't have an additional aid, so I'm glad to have one. I know as my recovery continues that that won't always be the case, ie, that if I didn't do odd things in my sleep, I wouldn't need the Clonazepam, that I'd be able to get to sleep on my own, that it is for the odd things in my sleep, but for now, while my legs are painful, the additional effect of it making me sleepy is a handy additional side effect, that I bless it for.
The replacement for the Geodon is . . . the medication that she'd lowered that caused her to want to add Geodon in the first place. She'd lowered my topirimate from 150mg a day to 100, and I'd reported feeling less stable on it. Thus, she'd added a more traditional mood stabilizer. She's not the psychiatrist who had initially prescribed topamax, now topirimate as generic, for mood stabilizing as an off-label use, and so I hadn't thought she'd be up for raising it back up. But she said that, "You know how you feel, you know what had been working, and how it felt when it was lowered, so we'll go back up." Or something like that. I'm guessing that after the last couple years of my having been tried on a couple different things, that the stable of mood stabilizers is getting down to things that would potentially cause a raise in blood sugar and/or even diabetes, which, for someone at my (yes, it's reduced, but still not a great weight for this) weight of 225-235 and 5 foot 7", is not the best idea.
So, I apologize for the long post, but there you have today's experience at the psychiatrist's office, with a little back history on the face. It's funny how the knee surgeries have brought up all the old issues with the face again, obviously I need to spend some time in therapy working through the face-changing issues that I never worked through at age 18. Working through all the baggage from growing up with the face that I was born with, which I'm sure my parents would say wasn't a bad face, but of course I couldn't get that surgery fast enough. I went through the equivalent of torture, in my young life. Both emotional, and physical. It's probably why I developed mental illnesses, in the first place, although maybe some was in the DNA, since my 2nd oldest brother also has ADD. I've read that untreated ADD can lead to developing bipolar, but there's no blame to my parents, because they didn't know about such things back then, and even when they did, it was more recognized in boys, than in girls. But it certainly wasn' t recognized in the 70's and early 80's, in girls. And who'd have had a clue about anxiety disorders, either? I'm pretty certain that I had THOSE before I was even 13, just thinking about how I was, but when you think about having to worry about being hit by a book or other stuff every day getting on the bus, you get battle weary pretty quick.
That phrase makes me wonder about PTSD . . . . like I need something else, anyway.
Nowadays if some kid was "pretend kidnapped" like me and my brother were, the two kids responsible for it, they were teenagers, they'd be arrested as juvies, for the circumstances and actions I remember. They seriously would be, nowadays. For treating us the way they did, burying us in leaves, taking us against our will, holding us against our will, telling us they'd kill us if we left, burying us until it was dark under the leaves, and saying they'd kill us until we were dead (the boys involved were 14 and 15, or 16, I believe, we were 11 and 12, I think) . . . . I can't remember how long we laid there, but it was a LONG time. They hauled us over a block, into the woods, against our will, and stood guard over us for awhile. I believe our parents spoke to the parents of one of the boys, but I can't remember, I was just terrified out of my skull. I never jumped in a leaf pile again, after that. Can't stand them.
Sunday, June 27, 2010
Geodon Failure
Well, the last two days have been NOT FUN.
Having a symptom show up less than twenty-four hours after bumping the Geodon dose up to three pills, was rather suspicious.
When undressing for the evening, I noticed a speckling of tiny bruises on my upper left thigh, in a V and then a dot farther up, almost as if something had traveled a path in my veins, or bled along a path, which freaked me out. I began wondering about strokes and other things, which is rather EXTREME, even for me with my anxiety disorders and panic disorder.
I literally thought I was going to DIE, so I took a Lorazepam, as directed, for agitation. I left a message with her office the next day, because I HAD had my last appointment with her on a Saturday, I figured she might pick it up (I marked it urgent) before she left for the day. Apparently she didn't.
Anxieties in full swing, I applied some cognitive behavioral techniques to calm myself down, a bit, as well as having talked on the phone with my mother-in-law.
Later in the day, I continued with the second day of the new dose of three pills, hoping nothing untoward would happen, but knowing that if it did, I'd be calling the prescribing psychiatrist's cell phone Sunday morning at a decent hour, because TWO symptoms in a row would be too much to ignore.
Well, something happened, within 4 hours of taking the second dose. With apologies for the graphicness, I had a bit of blood before a runny stool. I grew VERY alarmed, and was in panic mode, "I'm gonna die of a stroke, because if it's bleeding in various parts of my body, it could decide to bleed ANYWHERE!", being the type of thoughts I was having.
I took a Lorazepam again this night, as well as I requested for my husband to give me a priesthood blessing. What was said in the blessing calmed me down completely on the score of worrying about further symptoms from the Geodon; there would be no further ill effects, so I had faith that what was said in the blessing was true, because that's what I was raised to believe. To trust in the Lord, and the priesthood that the men in the church have to use in His name. Part of trusting in blessings like these is to also make use of modern medicine, and to not just leave everything up to faith; you are to still see your doctors, and make use of them as you normally would, so I did not cancel my intentions to call her in the morning about the symptoms. It is what a prudent person would do, after having had symptoms of unusual bleeding or bruising after recently upping the dose of a new medication as directed.
I called her this morning, and I'm to lower the dose back down to two 40mg pills, and to keep her informed about how things go.
Let me tell you, spending two days wondering if you might die, has not been fun, even though you KNOW it's the panic disorder, possibly aggravated by agitation-caused side effects of the Geodon, because you normally don't go to such extreme conclusions based on a little side effect or two like that. You would worry alot, but not think you would DIE right off the bat. I am SO grateful for blessings, too.
Now all I've got to worry about is the pain of taking off the tapings they did to my knees at physical therapy . . . oh, and what mood stabilizer are we going to try next?
As well as, getting to sleep is going to be harder, because when I was on two Geodons previously I was on the last of the Seroquel stepping down, and now I'm not, so I won't have as much sleepiness effect from the Geodons without that. Although they do make me a bit sleepy.
The low-dose aspirin I take, half a day away from the Geodon, that the pharmacist had said wouldn't be a problem with the Geodon if I only took ONE, since the Geodon bottle said to not take with aspirin, that I take for up to 6 months post surgery for blood thinning reasons, well, I think there was perhaps some interaction between the two of these to create the symptoms mentioned above. I can't remember if the psychiatrist knows about the aspirin or not, I think she does . . . . I'm going to not take today's, just to be safe, and then resume the aspirin tomorrow.
Having a symptom show up less than twenty-four hours after bumping the Geodon dose up to three pills, was rather suspicious.
When undressing for the evening, I noticed a speckling of tiny bruises on my upper left thigh, in a V and then a dot farther up, almost as if something had traveled a path in my veins, or bled along a path, which freaked me out. I began wondering about strokes and other things, which is rather EXTREME, even for me with my anxiety disorders and panic disorder.
I literally thought I was going to DIE, so I took a Lorazepam, as directed, for agitation. I left a message with her office the next day, because I HAD had my last appointment with her on a Saturday, I figured she might pick it up (I marked it urgent) before she left for the day. Apparently she didn't.
Anxieties in full swing, I applied some cognitive behavioral techniques to calm myself down, a bit, as well as having talked on the phone with my mother-in-law.
Later in the day, I continued with the second day of the new dose of three pills, hoping nothing untoward would happen, but knowing that if it did, I'd be calling the prescribing psychiatrist's cell phone Sunday morning at a decent hour, because TWO symptoms in a row would be too much to ignore.
Well, something happened, within 4 hours of taking the second dose. With apologies for the graphicness, I had a bit of blood before a runny stool. I grew VERY alarmed, and was in panic mode, "I'm gonna die of a stroke, because if it's bleeding in various parts of my body, it could decide to bleed ANYWHERE!", being the type of thoughts I was having.
I took a Lorazepam again this night, as well as I requested for my husband to give me a priesthood blessing. What was said in the blessing calmed me down completely on the score of worrying about further symptoms from the Geodon; there would be no further ill effects, so I had faith that what was said in the blessing was true, because that's what I was raised to believe. To trust in the Lord, and the priesthood that the men in the church have to use in His name. Part of trusting in blessings like these is to also make use of modern medicine, and to not just leave everything up to faith; you are to still see your doctors, and make use of them as you normally would, so I did not cancel my intentions to call her in the morning about the symptoms. It is what a prudent person would do, after having had symptoms of unusual bleeding or bruising after recently upping the dose of a new medication as directed.
I called her this morning, and I'm to lower the dose back down to two 40mg pills, and to keep her informed about how things go.
Let me tell you, spending two days wondering if you might die, has not been fun, even though you KNOW it's the panic disorder, possibly aggravated by agitation-caused side effects of the Geodon, because you normally don't go to such extreme conclusions based on a little side effect or two like that. You would worry alot, but not think you would DIE right off the bat. I am SO grateful for blessings, too.
Now all I've got to worry about is the pain of taking off the tapings they did to my knees at physical therapy . . . oh, and what mood stabilizer are we going to try next?
As well as, getting to sleep is going to be harder, because when I was on two Geodons previously I was on the last of the Seroquel stepping down, and now I'm not, so I won't have as much sleepiness effect from the Geodons without that. Although they do make me a bit sleepy.
The low-dose aspirin I take, half a day away from the Geodon, that the pharmacist had said wouldn't be a problem with the Geodon if I only took ONE, since the Geodon bottle said to not take with aspirin, that I take for up to 6 months post surgery for blood thinning reasons, well, I think there was perhaps some interaction between the two of these to create the symptoms mentioned above. I can't remember if the psychiatrist knows about the aspirin or not, I think she does . . . . I'm going to not take today's, just to be safe, and then resume the aspirin tomorrow.
Tuesday, June 22, 2010
Welcome to the Pharmaceutical Hassle of Utah's Medicaid
Well, I had my Medicaid orientation last week.
The GREAT news after getting on the horn today with the State Medicaid office is that the retroactive Medicaid cards I was supposed to have gotten, weren't screwed up and I wasn't accidentally applied for not retroactive. They must have gotten lost in the mail. Even better than the 90 days retroactive before my April 13th surgery on my right knee, is that it goes retroactive all the way to January first, which covers the home physical therapy and home rental of the knee machine rental from the FIRST, left knee, surgery, too! I hadn't thought that most of January would be covered! And, after the orientation last week, I had thought that, since I had only received a card for June, it sounded like I might only get the cards for the 90 days prior to JUNE, and not prior to my SURGERY date, and had resigned myself to only getting the last month of my previous surgery's physical therapy paid for, as well as the anesthesia from this surgery, which is the first bill that came through for it and maximized out our deductible . . .
I am also unsure of how to submit pharmacy expenses from earlier in the year, if I even can at all, which I probably can't. That was one thing I forgot to ask the benefits lady at the orientation, but I've got her number, so I can call and ask.
They're sending me new retroactive cards going back to the beginning of the year, but said I can use the number off of June to give to providers. It's a good thing that retroactive expenses do NOT need to be on the provider list with the plan I picked for June and going forward, because the plans they had did NOT have my orthopedic practice (knee, hip doctors), nor my physical therapy place, etc. For retroactive stuff they just pay it straight from the state, without going through a plan.
Anyway, now to the pharmaceutical stuff, which I was looking at today. There was NO NO NO mention in the orientation about something that happened a year ago, in our state legislature, but THAT's no surprise since they are working with printed books that are from 2008!!!! UGH UGH UGH UGH!!!! I mean, REALLY!!!
What happened in 2009, was this:
Direct from the horse's mouth, as it were. After looking through the two lists, there's only ONE of my medications on the "Preferred" list, and that's generic omeprazole. My other meds are Vyvanse, Geodon (still ramping this up), Lorazepam, topirimate (generic Topamax), and, not prescribed yet by the new psychiatrist but part of an as needed basis prescribed by previous psychiatrists and listed to the new one, and not told to stop, taken as needed when I remember which I usually don't, alprazolam, the generic for Xanax. The Lorazepam is also as needed, which I've only needed it once for agitation in the two and a half weeks I've been on Geodon now, and I suspect that that situation would have aggravated me Geodon or no.
Anyway, so I'm not concerned/worried about the Xanax, since I forget about it most of the time. That leaves four medications for my psychiatrist to get approved by Medicaid. Now, she doesn't TAKE Medicaid so she probably won't be used to this; Medicaid is contracted with Davis Behavioral/Mental Health, in Davis County, where I live.
I wrote once or more about how I had, once upon a time, seen them in the mid-90's for counseling; in fact, the time I tried to kill myself, was the week my counselor went on vacation, although there were MANY other factors at the time as well; THAT, though, was one of them - Having my ear to talk to taken away from me, when I was in the middle of so much . . . but that was a difficult time, when I understood so much LESS . . . I wrote, once or more, about how I had used their services, and then, several years later, tried to turn to Davis Mental Health again, and was told something like, unless you are funded from a certain source (I assumed, Medicaid or Medicare), we can't see you . . . funding cuts . . . They had previously seen me on a sliding scale, but couldn't see me at full price even, at this subsequent time. I then left, disbelieving, that society didn't even care if its citizens had any kind of mental health services . . . .
I eventually related that story, with assurances that I was now currently in treatment with a psychologist and psychiatrist, to my state's then-governor, Jon Huntsman, over the radio, KSL 1160, on a radio call-in show with Doug Wright as the host. I brought the issue of mental health issues and funding up, since it was the fact that the state hadn't picked up the slack in funding brought about by the federal dropping 7 mil in funding; the state had only picked up $2 million of it, and needed to pick up MORE of it, because people like ME had fallen through the cracks, like the story I just illustrated. The responded kindly and nicely and seemed to understand my point. Let me tell you, I was scared to DEATH, lol!
Anyway, back to the stupid Medicaid drug approval process. This is ASININE that it wasn't a part of last week's orientation!!! And then, to have 4 out of 5 medications not on the list? Heck, there wasn't even a category for anti-psychotics, or for mood stabilizers, or for antidepressants, or for ANY kind of mental health medication!!! Probably because of the cost, and probably why they want them approved . . . . stupid bunch of red TAPE!!!
Even though my insurance doesn't run out until the end of July, I'm going to ask her at the early July appt. to work on it; I'll have to print out copies of the form at the library, as our printer recently died. I hope she doesn't say, YOU do it. SHE has to, if you click through at that page and read the form . . . she's supposed to include a copy in my chart, for audit purposes, too. Not that she takes Medicaid, but since I'll be getting the medications using the Medicaid benefit after July, she'd better fill out the forms, I mean, what choice does she have?
I am not sure how I'll pay her after the insurance goes . . . like I say, Medicaid is contracted through Davis, but I'm a little leery, because what if we suddenly don't qualify, like if my husband gets really lucky with the job search on the pay rate? Yeah, one can wish, but maybe the Lord will bless us. What if that happens, and then I'd have to drop THAT psychiatrist, too? So that's why I'm leery, for one reason, to switch, even though I haven't been THAT happy with this new psychiatrist. Plus, we're currently trying a new medication, and I hate to switch in the middle of a trial.
I REALLY hate red tape, though. I do feel for the extra time an already burdened w/paperwork doctor must feel, BUT . . . I don't have a choice, here. Medicaid ain't much fun for the patient, either, people. I feel like a show dog being led around by the nose - go here, do that, get this treat that tastes like crap, go do that, jump through this hoop . . . . yada yada, etc.
The GREAT news after getting on the horn today with the State Medicaid office is that the retroactive Medicaid cards I was supposed to have gotten, weren't screwed up and I wasn't accidentally applied for not retroactive. They must have gotten lost in the mail. Even better than the 90 days retroactive before my April 13th surgery on my right knee, is that it goes retroactive all the way to January first, which covers the home physical therapy and home rental of the knee machine rental from the FIRST, left knee, surgery, too! I hadn't thought that most of January would be covered! And, after the orientation last week, I had thought that, since I had only received a card for June, it sounded like I might only get the cards for the 90 days prior to JUNE, and not prior to my SURGERY date, and had resigned myself to only getting the last month of my previous surgery's physical therapy paid for, as well as the anesthesia from this surgery, which is the first bill that came through for it and maximized out our deductible . . .
I am also unsure of how to submit pharmacy expenses from earlier in the year, if I even can at all, which I probably can't. That was one thing I forgot to ask the benefits lady at the orientation, but I've got her number, so I can call and ask.
They're sending me new retroactive cards going back to the beginning of the year, but said I can use the number off of June to give to providers. It's a good thing that retroactive expenses do NOT need to be on the provider list with the plan I picked for June and going forward, because the plans they had did NOT have my orthopedic practice (knee, hip doctors), nor my physical therapy place, etc. For retroactive stuff they just pay it straight from the state, without going through a plan.
Anyway, now to the pharmaceutical stuff, which I was looking at today. There was NO NO NO mention in the orientation about something that happened a year ago, in our state legislature, but THAT's no surprise since they are working with printed books that are from 2008!!!! UGH UGH UGH UGH!!!! I mean, REALLY!!!
What happened in 2009, was this:
Preferred Drug List
During the 2007 legislative session, the Utah State Legislature passed Senate Bill 42 allowing Medicaid to adopt a preferred drug list (PDL). During the 2009 legislative session, the State Legislature approved SB 87, which authorizes Utah Medicaid to require a Prior Authorization for non-preferred drugs. The PA requirement became effective May 18, 2009.
Direct from the horse's mouth, as it were. After looking through the two lists, there's only ONE of my medications on the "Preferred" list, and that's generic omeprazole. My other meds are Vyvanse, Geodon (still ramping this up), Lorazepam, topirimate (generic Topamax), and, not prescribed yet by the new psychiatrist but part of an as needed basis prescribed by previous psychiatrists and listed to the new one, and not told to stop, taken as needed when I remember which I usually don't, alprazolam, the generic for Xanax. The Lorazepam is also as needed, which I've only needed it once for agitation in the two and a half weeks I've been on Geodon now, and I suspect that that situation would have aggravated me Geodon or no.
Anyway, so I'm not concerned/worried about the Xanax, since I forget about it most of the time. That leaves four medications for my psychiatrist to get approved by Medicaid. Now, she doesn't TAKE Medicaid so she probably won't be used to this; Medicaid is contracted with Davis Behavioral/Mental Health, in Davis County, where I live.
I wrote once or more about how I had, once upon a time, seen them in the mid-90's for counseling; in fact, the time I tried to kill myself, was the week my counselor went on vacation, although there were MANY other factors at the time as well; THAT, though, was one of them - Having my ear to talk to taken away from me, when I was in the middle of so much . . . but that was a difficult time, when I understood so much LESS . . . I wrote, once or more, about how I had used their services, and then, several years later, tried to turn to Davis Mental Health again, and was told something like, unless you are funded from a certain source (I assumed, Medicaid or Medicare), we can't see you . . . funding cuts . . . They had previously seen me on a sliding scale, but couldn't see me at full price even, at this subsequent time. I then left, disbelieving, that society didn't even care if its citizens had any kind of mental health services . . . .
I eventually related that story, with assurances that I was now currently in treatment with a psychologist and psychiatrist, to my state's then-governor, Jon Huntsman, over the radio, KSL 1160, on a radio call-in show with Doug Wright as the host. I brought the issue of mental health issues and funding up, since it was the fact that the state hadn't picked up the slack in funding brought about by the federal dropping 7 mil in funding; the state had only picked up $2 million of it, and needed to pick up MORE of it, because people like ME had fallen through the cracks, like the story I just illustrated. The responded kindly and nicely and seemed to understand my point. Let me tell you, I was scared to DEATH, lol!
Anyway, back to the stupid Medicaid drug approval process. This is ASININE that it wasn't a part of last week's orientation!!! And then, to have 4 out of 5 medications not on the list? Heck, there wasn't even a category for anti-psychotics, or for mood stabilizers, or for antidepressants, or for ANY kind of mental health medication!!! Probably because of the cost, and probably why they want them approved . . . . stupid bunch of red TAPE!!!
Even though my insurance doesn't run out until the end of July, I'm going to ask her at the early July appt. to work on it; I'll have to print out copies of the form at the library, as our printer recently died. I hope she doesn't say, YOU do it. SHE has to, if you click through at that page and read the form . . . she's supposed to include a copy in my chart, for audit purposes, too. Not that she takes Medicaid, but since I'll be getting the medications using the Medicaid benefit after July, she'd better fill out the forms, I mean, what choice does she have?
I am not sure how I'll pay her after the insurance goes . . . like I say, Medicaid is contracted through Davis, but I'm a little leery, because what if we suddenly don't qualify, like if my husband gets really lucky with the job search on the pay rate? Yeah, one can wish, but maybe the Lord will bless us. What if that happens, and then I'd have to drop THAT psychiatrist, too? So that's why I'm leery, for one reason, to switch, even though I haven't been THAT happy with this new psychiatrist. Plus, we're currently trying a new medication, and I hate to switch in the middle of a trial.
I REALLY hate red tape, though. I do feel for the extra time an already burdened w/paperwork doctor must feel, BUT . . . I don't have a choice, here. Medicaid ain't much fun for the patient, either, people. I feel like a show dog being led around by the nose - go here, do that, get this treat that tastes like crap, go do that, jump through this hoop . . . . yada yada, etc.
Thursday, June 10, 2010
PsychoPharmacology: Make It Up As You Go, & Damn the Patient!
You want agitation? You got it!
I want to prove this lady WRONG.
WHY do I keep getting psychiatrists who won't LISTEN?
Even worse, being dismissive of my concerns, is rude, hurtful, potentially medically harmful, and insulting, besides being destructive towards the therapeutic relationship, if it can be said that my psychiatrist and I have much of one.
You don't have to DO what I say, but HEAR me, please! Give me the respect of listening; I thought that was part of your job. When it becomes SO obvious that you AREN'T LISTENING, I just want to tear my hair out!
Okay, so I go in today, and say that I feel less stable since she's had me lower my topirimate (generic for Topamax) dose from 150 to 100mg. She wasn't the original prescriber of this; my last psychiatrist was. I talk about why I feel less stable, and this she listens to.
I tel her I don't seem to be feeling any effect from the Seroquel, which had been upped from 300 to 400mg last time, other than the usual bedtime sleepiness; it is decided that the Seroquel isn't working.
She decides to prescribe Geodon, which is especially good for the manic side of bipolar, I'm not sure if it handles both sides . . . . she lists some of the effects, and side effects, noting that "it helps stop cravings for carbs.". She happens to sub-specialize in nutrional issues, not that I've ever mentioned a carb problem, but I respond with the fact that I have PCOS (Poly-cystic Ovarian Syndrome), which tends to cause its sufferers to crave carbs, and she seems delighted that this little aspect of the medication will be so suited to counter something I have.
Like carbs are a major issue, here. DEFINITELY not a priority, although since we're poor, pasta and rice are often on the menu.
Besides, this medication has the potential to raise my blood sugar, with the potential in some cases for diabetes, I think, as well as it has the potential to cause weight gain (the literature I got listed this weight gain for 7% of the schizophrenic patients and didn't mention anything about it for the bipolar patients, but I doubt the weight gain would discriminate between the two). Now, I may have recently lost some weight, but I weigh enough (around 240, right now) that putting me on a medication with these two potential side effects (which, as a difficulty for the psychiatrist, so many of the bipolar medications seem to have these, which is why I think I've been prescribed such non-traditional mood stabilizers, as a way to avoid those, esp when I was in the 280's and 290's) is a questionable thing to do, in my mind.
Still, I'm not the doctor, and as I mention above, the choices are limited for mood stabilizers that don't have at least one or both of those types of side effects, at least as far as the on-label approved for use goes. The Gabapentin, and then, the topirimate after it, were being used "off-label", ie, the FDA doesn't recognize them for use as mood stabilizers, and, in fact, in Gabapentin's case, I believe had come down on it's manufacturer for trying to promote it as such. I did feel some effect from it though, but topirimate has worked better, I believe.
So, my new psychiatrist prescribes Geodon, and some lorazepam in case I develop agitation on the early, low doses of Geodon, which happens sometime, to counter it.
She told me to stop taking my clonazepam, which makes sense considering she'd just prescribed what I'm guessing is another benzodiazepine, given the "-pam" extension, but it's just a mild sedative, it's not meant for countering the stuff I do when I'm asleep at night.
I asked her, what do I do about THAT? The stuff I do when I'm asleep, like yelling, hitting, etc.?
She said, very dismissively, and in a manner that felt like it was pulled out of thin air, "Up your dose of topirimate to counter that, it will act like the clonazepam did to stop that stuff", or something like that.
I'm assuming she means to up my dose, all at night, right before bed - she wasn't very specific.
I was stunned, though; in my years of taking topirimate, my previous psychiatrist had never mentioned this property, and most psychiatrists don't prescribe clonazepam or any other benzodiazepine casually; of course, he may have been prescribing it additioally for it's anti-anxiety effects, as I was to take a tiny portion in the morning, to help keep a constant level in the blood, and then of course my nighttime dose, but . . . you'd think he would have mentioned that the mood stabilizer I was taking would have substituted for the clonazepam to take care of all the night stuff, if indeed that was one of it's properties.
I absolutely frickin' don't believe it. It's a painkiller, that some people I know take, or took, for migraines; some take as a mood stabilizer, like me, and now it's got an additional property I'd never heard of??
I was just disbelievingly stunned, that she would dismiss my concerns so quickly, with something that sounded like fiction to me. It also sounded like she didn't give a fig what night symptoms I had, either.
Later, it occurred to me, that if I up my dose back to it's mood-stabilizing effective dose of 150, to counter the night stuff (even if it doesn't work for that), then why the hell would I be taking an additional medication to stabilize me? How would I know what effect would be coming from which medication, then? It would be two medications where only one was needed.
This is why I said, at the beginning of the post, you want agitation, you got it! How am I then supposed to tell, as I start taking this medication Geodon, if the agitation is because of IT, or because I'm pissed off at my psychiatrist for being so . . . . . idiotic.
I'm going to take extra topirimate before bed tonight, and hope I have yelling, screaming, kicking nightmares, so I can call her in the morning and tell her how wrong the hell she was, and what now does she recommend?
Cause I'm PISSED, and I can't risk endless nights of possibly punching my recently operated leg (ow), or waking up to it jerking and convulsing, like I did a week after I got out of the hospital (OW), or waking up to me yelling HELP! as if I'm being raped and murdered, liked I believed I was in the nightmare, and then hearing the people in the apartment above wake up and turn over and go deathly still, listening for further signs of attack, me holding my breath against them waking and coming downstairs to pound on the front door, relaxing when they finally relax and turn over back to sleep. I'm hoping I don't throw any left or right hooks though; that behavior seems to be fairly rare, thank goodness, but then I've been on clonazepam for quite some time so who knows how rare it is . . . . . . .
Here's hoping I prove that WOMAN wrong TONIGHT, despite it meaning nasty nightmares for me.
Now, if anyone knows if that med is supposed to have this effect, I'd appreciate a comment, but . . . . yeah, I know it's the internet, grain of salt, not my doctors.
I want to prove this lady WRONG.
WHY do I keep getting psychiatrists who won't LISTEN?
Even worse, being dismissive of my concerns, is rude, hurtful, potentially medically harmful, and insulting, besides being destructive towards the therapeutic relationship, if it can be said that my psychiatrist and I have much of one.
You don't have to DO what I say, but HEAR me, please! Give me the respect of listening; I thought that was part of your job. When it becomes SO obvious that you AREN'T LISTENING, I just want to tear my hair out!
Okay, so I go in today, and say that I feel less stable since she's had me lower my topirimate (generic for Topamax) dose from 150 to 100mg. She wasn't the original prescriber of this; my last psychiatrist was. I talk about why I feel less stable, and this she listens to.
I tel her I don't seem to be feeling any effect from the Seroquel, which had been upped from 300 to 400mg last time, other than the usual bedtime sleepiness; it is decided that the Seroquel isn't working.
She decides to prescribe Geodon, which is especially good for the manic side of bipolar, I'm not sure if it handles both sides . . . . she lists some of the effects, and side effects, noting that "it helps stop cravings for carbs.". She happens to sub-specialize in nutrional issues, not that I've ever mentioned a carb problem, but I respond with the fact that I have PCOS (Poly-cystic Ovarian Syndrome), which tends to cause its sufferers to crave carbs, and she seems delighted that this little aspect of the medication will be so suited to counter something I have.
Like carbs are a major issue, here. DEFINITELY not a priority, although since we're poor, pasta and rice are often on the menu.
Besides, this medication has the potential to raise my blood sugar, with the potential in some cases for diabetes, I think, as well as it has the potential to cause weight gain (the literature I got listed this weight gain for 7% of the schizophrenic patients and didn't mention anything about it for the bipolar patients, but I doubt the weight gain would discriminate between the two). Now, I may have recently lost some weight, but I weigh enough (around 240, right now) that putting me on a medication with these two potential side effects (which, as a difficulty for the psychiatrist, so many of the bipolar medications seem to have these, which is why I think I've been prescribed such non-traditional mood stabilizers, as a way to avoid those, esp when I was in the 280's and 290's) is a questionable thing to do, in my mind.
Still, I'm not the doctor, and as I mention above, the choices are limited for mood stabilizers that don't have at least one or both of those types of side effects, at least as far as the on-label approved for use goes. The Gabapentin, and then, the topirimate after it, were being used "off-label", ie, the FDA doesn't recognize them for use as mood stabilizers, and, in fact, in Gabapentin's case, I believe had come down on it's manufacturer for trying to promote it as such. I did feel some effect from it though, but topirimate has worked better, I believe.
So, my new psychiatrist prescribes Geodon, and some lorazepam in case I develop agitation on the early, low doses of Geodon, which happens sometime, to counter it.
She told me to stop taking my clonazepam, which makes sense considering she'd just prescribed what I'm guessing is another benzodiazepine, given the "-pam" extension, but it's just a mild sedative, it's not meant for countering the stuff I do when I'm asleep at night.
I asked her, what do I do about THAT? The stuff I do when I'm asleep, like yelling, hitting, etc.?
She said, very dismissively, and in a manner that felt like it was pulled out of thin air, "Up your dose of topirimate to counter that, it will act like the clonazepam did to stop that stuff", or something like that.
I'm assuming she means to up my dose, all at night, right before bed - she wasn't very specific.
I was stunned, though; in my years of taking topirimate, my previous psychiatrist had never mentioned this property, and most psychiatrists don't prescribe clonazepam or any other benzodiazepine casually; of course, he may have been prescribing it additioally for it's anti-anxiety effects, as I was to take a tiny portion in the morning, to help keep a constant level in the blood, and then of course my nighttime dose, but . . . you'd think he would have mentioned that the mood stabilizer I was taking would have substituted for the clonazepam to take care of all the night stuff, if indeed that was one of it's properties.
I absolutely frickin' don't believe it. It's a painkiller, that some people I know take, or took, for migraines; some take as a mood stabilizer, like me, and now it's got an additional property I'd never heard of??
I was just disbelievingly stunned, that she would dismiss my concerns so quickly, with something that sounded like fiction to me. It also sounded like she didn't give a fig what night symptoms I had, either.
Later, it occurred to me, that if I up my dose back to it's mood-stabilizing effective dose of 150, to counter the night stuff (even if it doesn't work for that), then why the hell would I be taking an additional medication to stabilize me? How would I know what effect would be coming from which medication, then? It would be two medications where only one was needed.
This is why I said, at the beginning of the post, you want agitation, you got it! How am I then supposed to tell, as I start taking this medication Geodon, if the agitation is because of IT, or because I'm pissed off at my psychiatrist for being so . . . . . idiotic.
I'm going to take extra topirimate before bed tonight, and hope I have yelling, screaming, kicking nightmares, so I can call her in the morning and tell her how wrong the hell she was, and what now does she recommend?
Cause I'm PISSED, and I can't risk endless nights of possibly punching my recently operated leg (ow), or waking up to it jerking and convulsing, like I did a week after I got out of the hospital (OW), or waking up to me yelling HELP! as if I'm being raped and murdered, liked I believed I was in the nightmare, and then hearing the people in the apartment above wake up and turn over and go deathly still, listening for further signs of attack, me holding my breath against them waking and coming downstairs to pound on the front door, relaxing when they finally relax and turn over back to sleep. I'm hoping I don't throw any left or right hooks though; that behavior seems to be fairly rare, thank goodness, but then I've been on clonazepam for quite some time so who knows how rare it is . . . . . . .
Here's hoping I prove that WOMAN wrong TONIGHT, despite it meaning nasty nightmares for me.
Now, if anyone knows if that med is supposed to have this effect, I'd appreciate a comment, but . . . . yeah, I know it's the internet, grain of salt, not my doctors.
Monday, March 22, 2010
A Quick Call to the Psychiatrist, Regretted
Ooooh, am I so peeved at this woman!
Then again, why WOULD she know who the hell I was, calling, anyway? I'm just a new patient.
Don't put down your cell for pressing matters if you don't want it called. Of course, ones' definition of pressing might differ from someone else's, but it was 9 minutes after her office closed, and the call was 90 seconds or less, so I figured it wasn't a huge bother. It could have been longer, had she not acted the way she did, but she REALLY did not represent herself very well at all. Then again, since she had no idea who the bloody hell was calling her, that's probably partly why I'm pissed off.
Still, all my defenses are going to be UP UP UP like you wouldn't believe, when next I meet with her, and the pressing need behind the call is going to stay buried. From her, at any rate. My psychologist will know, but hell if she will, and I don't give a damn if that means my treatment isn't correct because she needs to damn well earn my trust, and act like a doctor, a psychiatrist with at least a SPECK of empathy, and not a bitch.
Strong language, but the phone call was . . . . jarring. I sincerely regret ever picking up the phone to call that woman. I give her 4 appointments to see if this relationship is workable.
I don't know if I have it in me to seek another psychiatrist, but for my own health I shouldn't give up on psychiatrists entirely, and I know I'm catastrophizing and over-magnifying and blowing things out of proportion, partly because of how infinitely STUPID I feel after that short phone call. All sorts of distorted thinking & thought patterns . . . . it's just, . . . .
I'm like a dry tinderbrush right now, and anything could light me afire at this point. Even the stress of thinking about going to see her, after that stupidness of a phone call. I'm too impulsive, and that call is one impulse I really, really regret. If she's any kind of a psychiatrist at all, she hopefully won't try to make me feel stupid (er) than I already feel about it. If she does, I'll take that as a sign that she's got no sense of empathy or speck of human connectedness about her at all. Which would make me wonder what the heck kind of psychiatrist she is, anyway.
See, though all of this flailing around wondering, spurred on by my embarrassment over a teeny phone call where little was said, is a whole lot of to-do over what is likely nothing. Making straw men out of nothing. Making up potential issues where none may exist.
So we'll see, but as I say, I'm going to have all my armor on because I'm tired of feeling emotionally beaten up or having the rug pulled out from under me and bloody surprised like the way I was at the first appointment; she's got to EARN my trust after THAT stupid maneuver, as well as after her manner with me on the phone, granted that she didn't know I was a patient for half of the very short phone call, though.
Anyway, UGH. Despite the shortcomings of my first two psychiatrists, at least I knew that they genuinely cared for my well-being. Also, neither of them thought I was stupid or annoying, as far as I knew. Well, my first one was sometimes . . . well, it depended. In the end, though, I knew he was sincere.
See, this seeing a woman psychiatrist thing is fraught with a psychological minefield, in addition to all the other problems that have come up. I have plenty of reasons not to trust women.
Then again, why WOULD she know who the hell I was, calling, anyway? I'm just a new patient.
Don't put down your cell for pressing matters if you don't want it called. Of course, ones' definition of pressing might differ from someone else's, but it was 9 minutes after her office closed, and the call was 90 seconds or less, so I figured it wasn't a huge bother. It could have been longer, had she not acted the way she did, but she REALLY did not represent herself very well at all. Then again, since she had no idea who the bloody hell was calling her, that's probably partly why I'm pissed off.
Still, all my defenses are going to be UP UP UP like you wouldn't believe, when next I meet with her, and the pressing need behind the call is going to stay buried. From her, at any rate. My psychologist will know, but hell if she will, and I don't give a damn if that means my treatment isn't correct because she needs to damn well earn my trust, and act like a doctor, a psychiatrist with at least a SPECK of empathy, and not a bitch.
Strong language, but the phone call was . . . . jarring. I sincerely regret ever picking up the phone to call that woman. I give her 4 appointments to see if this relationship is workable.
I don't know if I have it in me to seek another psychiatrist, but for my own health I shouldn't give up on psychiatrists entirely, and I know I'm catastrophizing and over-magnifying and blowing things out of proportion, partly because of how infinitely STUPID I feel after that short phone call. All sorts of distorted thinking & thought patterns . . . . it's just, . . . .
I'm like a dry tinderbrush right now, and anything could light me afire at this point. Even the stress of thinking about going to see her, after that stupidness of a phone call. I'm too impulsive, and that call is one impulse I really, really regret. If she's any kind of a psychiatrist at all, she hopefully won't try to make me feel stupid (er) than I already feel about it. If she does, I'll take that as a sign that she's got no sense of empathy or speck of human connectedness about her at all. Which would make me wonder what the heck kind of psychiatrist she is, anyway.
See, though all of this flailing around wondering, spurred on by my embarrassment over a teeny phone call where little was said, is a whole lot of to-do over what is likely nothing. Making straw men out of nothing. Making up potential issues where none may exist.
So we'll see, but as I say, I'm going to have all my armor on because I'm tired of feeling emotionally beaten up or having the rug pulled out from under me and bloody surprised like the way I was at the first appointment; she's got to EARN my trust after THAT stupid maneuver, as well as after her manner with me on the phone, granted that she didn't know I was a patient for half of the very short phone call, though.
Anyway, UGH. Despite the shortcomings of my first two psychiatrists, at least I knew that they genuinely cared for my well-being. Also, neither of them thought I was stupid or annoying, as far as I knew. Well, my first one was sometimes . . . well, it depended. In the end, though, I knew he was sincere.
See, this seeing a woman psychiatrist thing is fraught with a psychological minefield, in addition to all the other problems that have come up. I have plenty of reasons not to trust women.
Monday, March 15, 2010
How It Is, & Thanks Shrink Rap!
Dinah, of the Shrink Rap blog, was true to her word and wrote a post regarding what I described in my previous post here, about my Psychiatry Bait-and-Switch experience, as I title it below. She titles her post, "Hey, What are YOU Doing Here?", and then talks about what her experiences as a psychiatrist have been at different facilities as well as in her own private practice have been in regards to the initial interview and the procedures for it, as well as what the standards are for it as laid out by the American Psychiatric Association (I think).
In the comments, one commenter/psychiatrist brings up sections of the American Medical Association's recommendations & guidelines for practices relating to issues regarding how a psychiatrist should conduct ones' self regarding splitting duties/fees, (at least it is implied that if you are splitting the duties that much, then isn't much of the fee for the session going to the person doing much of the work, thus splitting the fee?) . . . . as well as allowing ones' self, as the psychiatrist, to be used as a figurehead, not being in the patients best interest at all.
I thought those were VERY interesting and informative to read about. Both the post, including the standards from the APA, and in the comments, the further standards and guidelines especially directed towards psychiatrists, from the AMA . . . .
It's an interesting discussion, of which some has spilled over into the comments on my own post, entitled Psychiatry Bait-and-Switch, here on my own blog, from people who followed the link to that post from the Shrink Rap blog. Please feel free to join in the discussion there.
It is heartening to see that there are doctors out there who do not support behavior that is so fringe and will speak up to inform about the profession, and who are embarrassed on behalf of their fellow psychiatrists, and that there are those who care enough to post an informative post for me like that; Dinah, I really appreciate it.
I know it's my own choice about what to do about my own health care, and given everything going on with me, at present I feel that it's best that I'm under a psychiatrist's care, than none at all. That should tell you something, about the pressures I am under. How trapped I feel by circumstances beyond my control.
I added up all the medical expenses from March and expected medical expenses through the end of May and it adds up to $1800 or more, just shy of what we need to hit the deductible - I really don't want to go into surgery without it being met, but it's not like we have $1800 in 2.5 months to meet all these expenses, either, let alone the $2800 the MRI people want. So I'm shutting down, because I can't cope with the reality of the life that is in front of me.
I. Can't. Handle. It.
And.
I am in constant pain, that is wearing me down, and I don't know if I'll have the OOOMPH and the willpower to bull through and do the painful work needed to recover from another surgery, let alone continue with the work needed to continue with my current recovery. I'm feeling so burned out. OUT. OUT OUT OUT.
EMPATHY is NOWHERE TO BE FOUND, and I AM ALONE as if there was NO ONE. ALL. BLOODY. BY. MY. SELF. and it hurts.
I can't think my way out of this one. Money doesn't grow on trees, and recovery doesn't happen overnight.
So, as long as there's no more Energy Healer, and I can scrape up the dough from somewhere for both meds and visits to see her, I'll go to the psychiatrist unless something untoward happens, with constant revisions as time and experience go on, with her. My condition requires being in someone's care, right now. Those are big ifs, though. If I can't afford the care I need, then I'll just have to, well, say that mental health care is unaffordable, both the doctor visits, and the medication. Even if it is essential. Even if this is America, where you aren't supposed to be in danger because you can't afford health care. Who says? That's the way our system is.
I'm tempted to not post this, but I want to lay bare the real truth of how it is, so here's how it is.
In the comments, one commenter/psychiatrist brings up sections of the American Medical Association's recommendations & guidelines for practices relating to issues regarding how a psychiatrist should conduct ones' self regarding splitting duties/fees, (at least it is implied that if you are splitting the duties that much, then isn't much of the fee for the session going to the person doing much of the work, thus splitting the fee?) . . . . as well as allowing ones' self, as the psychiatrist, to be used as a figurehead, not being in the patients best interest at all.
I thought those were VERY interesting and informative to read about. Both the post, including the standards from the APA, and in the comments, the further standards and guidelines especially directed towards psychiatrists, from the AMA . . . .
It's an interesting discussion, of which some has spilled over into the comments on my own post, entitled Psychiatry Bait-and-Switch, here on my own blog, from people who followed the link to that post from the Shrink Rap blog. Please feel free to join in the discussion there.
It is heartening to see that there are doctors out there who do not support behavior that is so fringe and will speak up to inform about the profession, and who are embarrassed on behalf of their fellow psychiatrists, and that there are those who care enough to post an informative post for me like that; Dinah, I really appreciate it.
I know it's my own choice about what to do about my own health care, and given everything going on with me, at present I feel that it's best that I'm under a psychiatrist's care, than none at all. That should tell you something, about the pressures I am under. How trapped I feel by circumstances beyond my control.
I added up all the medical expenses from March and expected medical expenses through the end of May and it adds up to $1800 or more, just shy of what we need to hit the deductible - I really don't want to go into surgery without it being met, but it's not like we have $1800 in 2.5 months to meet all these expenses, either, let alone the $2800 the MRI people want. So I'm shutting down, because I can't cope with the reality of the life that is in front of me.
I. Can't. Handle. It.
And.
I am in constant pain, that is wearing me down, and I don't know if I'll have the OOOMPH and the willpower to bull through and do the painful work needed to recover from another surgery, let alone continue with the work needed to continue with my current recovery. I'm feeling so burned out. OUT. OUT OUT OUT.
EMPATHY is NOWHERE TO BE FOUND, and I AM ALONE as if there was NO ONE. ALL. BLOODY. BY. MY. SELF. and it hurts.
I can't think my way out of this one. Money doesn't grow on trees, and recovery doesn't happen overnight.
So, as long as there's no more Energy Healer, and I can scrape up the dough from somewhere for both meds and visits to see her, I'll go to the psychiatrist unless something untoward happens, with constant revisions as time and experience go on, with her. My condition requires being in someone's care, right now. Those are big ifs, though. If I can't afford the care I need, then I'll just have to, well, say that mental health care is unaffordable, both the doctor visits, and the medication. Even if it is essential. Even if this is America, where you aren't supposed to be in danger because you can't afford health care. Who says? That's the way our system is.
I'm tempted to not post this, but I want to lay bare the real truth of how it is, so here's how it is.
Thursday, March 11, 2010
Psychiatry Bait-and-Switch
New patient appointments with psychiatrists are usually 90 minute appointments, and subsequent appointments are generally 15 to 20 minutes to deal with medication issues, unless you are also seeing the psychiatrist for your psychotherapy, which many insurance companies don't like anymore.
I do not know if it is an acceptable practice for a psychiatrist to "farm out" part of the initial interview to a colleague at their practice, such as an LCSW (Licensed Clinical Social Worker) or other mental health professional, and then come in for the last 20-25 minutes and be filled in on the most pertinent details (things like family history that I had already addressed in the New Patient Information packet that I had been asked about again in the interview were not brought up in this "fill in the psychiatrist" process, thank goodness; perhaps it was assumed that she had read the history, and that she'd read the interviewer's full notes later) . . . . . .
I do not know if such a thing as this is an acceptable or accepted practice . . . I do not know what my insurance company would say about it, either.
Shockingly, I wasn't interviewed by anyone I'd consider a mental health professional, though I think the people within the group practice there might disagree. I was interviewed by an Energy Healer. AN ENERGY HEALER. Of all the mumbo jumbo hocus pocus crap, pardon my language . . . . . this is fine, for those who believe in it. It is not fine for me, because this is not what I was there for, and despite the fact that her "degree" includes courses in psychology and psychodynamics (when I first went there to fill out the new patient forms, I picked up the business cards of everyone there, and a flyer or two, including the one for this Energy Healer, to take home with me to read, to get a "feel" for this different kind of a place that I'd be going to), I do not consider her a mental health professional.
I also consider it a wasted opportunity on the part of the psychiatrist, because with the limited time we are allowed in subsequent "med check" appointments by the insurance company, she has missed the opportunity allowed in this first, longer appointment in getting to know me that she could have had in interviewing me herself.
Now, if her practice is busy enough that she can't take new patients on without farming part of the interview out to a colleague, then at least do it to one of the LCSW's or PC (personal counselor? professional counselor?) at the practice, and not to the energy healer . . . . .
With as long as it took me to find a psychiatrist last time, and as quickly as I found one this time (although that might be a warning sign, I don't know, although the open philosophy the practice holds would indicate, I HOPE, that they'd not try to force one down a path you aren't comfortable with), I AM happy to have gotten in to a psychiatrist at all, AND the time I DID spend with her (none of it one-on-one, though, the energy healer was still in the room the whole time) I thought she was sharp, in a good way, on the ball, knew her stuff, made a decent impression for the negative impressions that I'd already had going, having been thrown for a loop or two by being farmed out to the energy healer, and a really negative interaction with the office staff at the front desk, which was another throw-me-for-a-loop interaction that is causing a huge amount of anxiety.
The thing is, I cautiously quite like her; the psychiatrist, that is. Based on the little time I had with her.
Counter-balancing that, though, is the resentment at being forced to open up to someone that I'd never have opened up to, had I not been forced to. She's not going to be part of my ongoing visits, as the med checks will be with the psychiatrist herself, but when my arthritis and the prognosis would come up it was assumed that what the doctors had said about my future wasn't really how things had to be, because what the Energy Healer does is supposedly supposed to change that kind of thing. I resent that she or they assumed that I was or would buy into that way of thinking, as well. Although, since that's their worldview, how could they not think that way? It would be like asking them to be something other than who they are, so I suppose I couldn't ask anything else.
At my next appointment, my problem with the staff in the office will be mentioned, unless the anxiety becomes so great that I have to call her and mention it before then (ie, it might prevent me from coming back, and if it does so, I may be done with psychiatrists forever), as well as my resentment at being forced to open up to someone that I was not prepared or expected to open up to, that I would not naturally trust, will also be mentioned. These things are important to maintain a good working, trusting therapeutic relationship between the psychiatrist and myself, although I worry about complaining about the office staff, as well as complaining about the procedures she's established for taking on new patients. I have to counter-balance those worries with how much anxiety the office staff interaction has and is causing me, as well as the amount of resentment caused by the bait-and-switch thing, the amount of resentment caused by the fact that I never would have opened up to this other woman if I hadn't have been forced to.
I still wonder if it makes me a bit of a, pardon my language, bitch, that I had this office staff problem, and problem with the new patient procedure, though. Still, on the latter, I've never HEARD of anything like it, especially involving a non-mental health professional, at least as most of the mainstream world would define the term . . . . .
I was raised to be a bit leery of psychiatry/psychiatrists, and this whole experience just leaves me extremely unsettled, despite the fact that the psychiatrist seemed really good, although I don't have much to go on, there, and I have to make some judgements of her based on more than our interactions; I have to judge her on her intake procedures, office polices, and other things.
She's got me titrating up EXTREMELY QUICKLY on Seroquel, so we'll see how that goes; depending on side effects, we may slow it down a little.
I'm hoping that the peeps over at Shrink Rap see this post, and respond with a post on if they've ever heard of acceptable or not practice of farming out part of the new patient intake interview . . . . whether it be to a more mainstream mental health professional with a lesser degree, or to a more odd "specialty" such as happened to me. Even if it's acceptable within the profession, it's still a missed opportunity on the part of the psychiatrist, as I stated above, to get a good read on the patient.
I see her again in a couple of weeks, on a Saturday morning of all things!
I do not know if it is an acceptable practice for a psychiatrist to "farm out" part of the initial interview to a colleague at their practice, such as an LCSW (Licensed Clinical Social Worker) or other mental health professional, and then come in for the last 20-25 minutes and be filled in on the most pertinent details (things like family history that I had already addressed in the New Patient Information packet that I had been asked about again in the interview were not brought up in this "fill in the psychiatrist" process, thank goodness; perhaps it was assumed that she had read the history, and that she'd read the interviewer's full notes later) . . . . . .
I do not know if such a thing as this is an acceptable or accepted practice . . . I do not know what my insurance company would say about it, either.
Shockingly, I wasn't interviewed by anyone I'd consider a mental health professional, though I think the people within the group practice there might disagree. I was interviewed by an Energy Healer. AN ENERGY HEALER. Of all the mumbo jumbo hocus pocus crap, pardon my language . . . . . this is fine, for those who believe in it. It is not fine for me, because this is not what I was there for, and despite the fact that her "degree" includes courses in psychology and psychodynamics (when I first went there to fill out the new patient forms, I picked up the business cards of everyone there, and a flyer or two, including the one for this Energy Healer, to take home with me to read, to get a "feel" for this different kind of a place that I'd be going to), I do not consider her a mental health professional.
I also consider it a wasted opportunity on the part of the psychiatrist, because with the limited time we are allowed in subsequent "med check" appointments by the insurance company, she has missed the opportunity allowed in this first, longer appointment in getting to know me that she could have had in interviewing me herself.
Now, if her practice is busy enough that she can't take new patients on without farming part of the interview out to a colleague, then at least do it to one of the LCSW's or PC (personal counselor? professional counselor?) at the practice, and not to the energy healer . . . . .
With as long as it took me to find a psychiatrist last time, and as quickly as I found one this time (although that might be a warning sign, I don't know, although the open philosophy the practice holds would indicate, I HOPE, that they'd not try to force one down a path you aren't comfortable with), I AM happy to have gotten in to a psychiatrist at all, AND the time I DID spend with her (none of it one-on-one, though, the energy healer was still in the room the whole time) I thought she was sharp, in a good way, on the ball, knew her stuff, made a decent impression for the negative impressions that I'd already had going, having been thrown for a loop or two by being farmed out to the energy healer, and a really negative interaction with the office staff at the front desk, which was another throw-me-for-a-loop interaction that is causing a huge amount of anxiety.
The thing is, I cautiously quite like her; the psychiatrist, that is. Based on the little time I had with her.
Counter-balancing that, though, is the resentment at being forced to open up to someone that I'd never have opened up to, had I not been forced to. She's not going to be part of my ongoing visits, as the med checks will be with the psychiatrist herself, but when my arthritis and the prognosis would come up it was assumed that what the doctors had said about my future wasn't really how things had to be, because what the Energy Healer does is supposedly supposed to change that kind of thing. I resent that she or they assumed that I was or would buy into that way of thinking, as well. Although, since that's their worldview, how could they not think that way? It would be like asking them to be something other than who they are, so I suppose I couldn't ask anything else.
At my next appointment, my problem with the staff in the office will be mentioned, unless the anxiety becomes so great that I have to call her and mention it before then (ie, it might prevent me from coming back, and if it does so, I may be done with psychiatrists forever), as well as my resentment at being forced to open up to someone that I was not prepared or expected to open up to, that I would not naturally trust, will also be mentioned. These things are important to maintain a good working, trusting therapeutic relationship between the psychiatrist and myself, although I worry about complaining about the office staff, as well as complaining about the procedures she's established for taking on new patients. I have to counter-balance those worries with how much anxiety the office staff interaction has and is causing me, as well as the amount of resentment caused by the bait-and-switch thing, the amount of resentment caused by the fact that I never would have opened up to this other woman if I hadn't have been forced to.
I still wonder if it makes me a bit of a, pardon my language, bitch, that I had this office staff problem, and problem with the new patient procedure, though. Still, on the latter, I've never HEARD of anything like it, especially involving a non-mental health professional, at least as most of the mainstream world would define the term . . . . .
I was raised to be a bit leery of psychiatry/psychiatrists, and this whole experience just leaves me extremely unsettled, despite the fact that the psychiatrist seemed really good, although I don't have much to go on, there, and I have to make some judgements of her based on more than our interactions; I have to judge her on her intake procedures, office polices, and other things.
She's got me titrating up EXTREMELY QUICKLY on Seroquel, so we'll see how that goes; depending on side effects, we may slow it down a little.
I'm hoping that the peeps over at Shrink Rap see this post, and respond with a post on if they've ever heard of acceptable or not practice of farming out part of the new patient intake interview . . . . whether it be to a more mainstream mental health professional with a lesser degree, or to a more odd "specialty" such as happened to me. Even if it's acceptable within the profession, it's still a missed opportunity on the part of the psychiatrist, as I stated above, to get a good read on the patient.
I see her again in a couple of weeks, on a Saturday morning of all things!
Sunday, March 07, 2010
In Which I Go To Church, & Burst Into Tears
Today I went to part of my church's worship service, the main meeting: Sacrament Meeting. The other two parts, well for women, are Relief Society, and Sunday School. For men, depending on which Priesthood one is called to, you go to Elders Quorum, or High Priests'. Then it is Sunday School, along with the women.
Now, some congregations have their Sacrament meeting first, before these other meetings/lessons, and some have them last. Ours has it last. Part of the reason is we meet in our building with several other congregations, or "wards", as our term is, and we have to stagger the schedules. Often, it is felt, that if Sacrament meeting is held last, that some people will feel that they can come to church late, which is not something the leaders want to encourage, and so it is more often practiced, when possible, that Sacrament meeting is first. Still, it is sometimes not possible to always do so.
Anyway, that's more than you likely ever wanted to know about the LDS Sunday Meeting schedule, lol, and that doesn't even take into account the Primary (which is the children) or the Young Women & Young Men's groups, either.
So, today was the first time since surgery that I've been to church. I could have gone back earlier, but I haven't. Going to church is a HUGE anxiety disorder issue for me. I mean HUGE. Being around all those people, ESPECIALLY crossing over the threshold into the chapel . . .
Today, though, my tears had naught to do with the anxiety disorder, at least, not how you might think . . . .
After I'd been sitting on the back bench for a few minutes, right before the meeting was about to start, a familiar feeling in my left leg and knee brought me up short and aware and I looked around at the benches and behind me to the overflow area at the padded folding chairs, and I was filled with horror - every seating surface I could see was angled, with the front edge higher than the rear edge.
If you don't know because you may not have read the posts about earlier in my recovery from this total knee replacement, I have been having an odd side effect that the surgeon has never heard of, which I talked to him about a bit at my recent appointment, just a little. When I sit on chairs or surfaces that are angled upward at the front edge, from the back, ie, the front edge is higher than the back end/edge of the seating surface, something in the way it presses against the back of my leg/thigh somehow causes an escalating pain reacting in the knee that he recently replaced, which is still recovering. I'm guessing there's some nerve(s) or bundle thereof that sends a signal to a bad spot, setting off a chain reaction . . . perhaps it's a quirk of my anatomy, or perhaps when they were cleaning out all the junk in the area when they were getting ready to put stuff in, something wierd happened, I don't know.
But bad things happen, when I sit on surfaces like that, and the longer I sit on them, the worse it gets. Even when it is not a steep angle at all. I certainly hope this is not a permanent condition; I hope it resolves within the year that it takes to recover completely from the surgery. I hate to feel like Goldilocks, complaining about this or that.
When I looked around in horror, realizing that everything around me in the chapel, was constructed in a way that would cause me escalating pain, I burst into tears, even as a song began that entreated one not to despair, and to count one's blessings . . . . and I thought, "How could God do this, how can I come here and be in PAIN, how am I expected to do this, this seems so WRONG . . . .", all the while the verse went on, saying to not discourage, etcetera . . . . . and I was bawling my eyes out.
It was a tough couple of minutes, that. Of course, it isn't God that did it to me, nor even the surgeon, really. It's not like he's ever heard of this happening before, and we'll pray that it doesn't become permanent. It's not as severe as it was at three weeks, although I'm four times as many weeks out now and I still have the effect, so I'm a bit worried . . . . . I also hope it doesn't happen to the other leg; if it does, I'd assume it's a quirk of my particular anatomy, but . . . that would still suck. Again, though, I'm not going to assume it's going to repeat itself. I'm going to assume it resolves before the year is out, but keep an eye on it's progress, because at 6 months if it is still appreciable that will worry me . . . . you don't notice how many seating surfaces fall under this category until you have a problem with them.
I spoke with the Bishop, who is what another type of congregation might call a pastor, except ours is unpaid, and is "called" out of the general population of the ward, generally every five years although the period of service can vary, as seems to be the case with this one, after the meeting, about why I'd burst into tears so suddenly right as the meeting started. I'd noticed the Bishopric's startlement and attention when I'd done so (I did so silently, but they did see and notice, as they are a caring trio), as of course it would have seemed to have come out of the blue for no reason. He said, well, remind me next week, but we don't want you to be in pain; we'll pull in one of the chairs from the foyer (lobby) for you.
I was quite startled by that! These are like soft, wing chairs one might see in a house or a nice waiting area of a reception area of somewhere, and comfortable. You might see these in someone's LIVING ROOM . . . . even more so than where I just said, really. So now I'm worried that people might think, "Who is SHE so special that she gets a special chair, in the Chapel, anyway?". I even said that to somebody, a former Bishop of the ward, and he said, "Nah, we're not like that here, and we wouldn't want you to be in pain; we'll make sure that you are set up just right."
So it sounds like things will be okay, but I'm still going to stick out like a sore thumb, which is going to set off my anxiety disorders like fire alarm bells ringing, despite what the last gentleman said; I'll keep trying to repeat his kind words in my head, but I have a hard enough time with my anxieties and going there, and being in a situation that's going to make me stick out in a way that's going to cause stares and whispers and attention is, um, well . . . for a person like me, it is kind of a nightmare.
Even if he says people aren't like that. People are people, and something so out of the ordinary (and never in the years I was going more regularly did I ever see someone sitting in a soft wing chair in Sacrament Meeting) is going to cause a stir. How to handle it is the problem, and I don't have a session with my psychologist until the Tuesday AFTER next Sunday.
Oh, and to make matters worse, my husband WORKS next Sunday, so I'll be flying solo, so to speak. A neighbor will take my daughter to church for the whole thing, then run back here to get me in time for Sacrament Meeting (as the same angled padded folding chairs are the seats in Relief Society and Sunday School, I'm not sure how to handle the rest of the schedule; I can't expect them to haul around a big 'ole chair around the church just for me, and I know I can't sit on angled chairs for three hours either or I'd be screaming in pain too.)
I didn't think of the seating for the rest of the schedule issue until after we'd left church. I can't begin to impose on anyone for THAT, so I guess I'm stuck for now. We'll see. Sacrament Meeting for now, that's the most important part, being able to partake of the sacrament, anyway.
Now, some congregations have their Sacrament meeting first, before these other meetings/lessons, and some have them last. Ours has it last. Part of the reason is we meet in our building with several other congregations, or "wards", as our term is, and we have to stagger the schedules. Often, it is felt, that if Sacrament meeting is held last, that some people will feel that they can come to church late, which is not something the leaders want to encourage, and so it is more often practiced, when possible, that Sacrament meeting is first. Still, it is sometimes not possible to always do so.
Anyway, that's more than you likely ever wanted to know about the LDS Sunday Meeting schedule, lol, and that doesn't even take into account the Primary (which is the children) or the Young Women & Young Men's groups, either.
So, today was the first time since surgery that I've been to church. I could have gone back earlier, but I haven't. Going to church is a HUGE anxiety disorder issue for me. I mean HUGE. Being around all those people, ESPECIALLY crossing over the threshold into the chapel . . .
Today, though, my tears had naught to do with the anxiety disorder, at least, not how you might think . . . .
After I'd been sitting on the back bench for a few minutes, right before the meeting was about to start, a familiar feeling in my left leg and knee brought me up short and aware and I looked around at the benches and behind me to the overflow area at the padded folding chairs, and I was filled with horror - every seating surface I could see was angled, with the front edge higher than the rear edge.
If you don't know because you may not have read the posts about earlier in my recovery from this total knee replacement, I have been having an odd side effect that the surgeon has never heard of, which I talked to him about a bit at my recent appointment, just a little. When I sit on chairs or surfaces that are angled upward at the front edge, from the back, ie, the front edge is higher than the back end/edge of the seating surface, something in the way it presses against the back of my leg/thigh somehow causes an escalating pain reacting in the knee that he recently replaced, which is still recovering. I'm guessing there's some nerve(s) or bundle thereof that sends a signal to a bad spot, setting off a chain reaction . . . perhaps it's a quirk of my anatomy, or perhaps when they were cleaning out all the junk in the area when they were getting ready to put stuff in, something wierd happened, I don't know.
But bad things happen, when I sit on surfaces like that, and the longer I sit on them, the worse it gets. Even when it is not a steep angle at all. I certainly hope this is not a permanent condition; I hope it resolves within the year that it takes to recover completely from the surgery. I hate to feel like Goldilocks, complaining about this or that.
When I looked around in horror, realizing that everything around me in the chapel, was constructed in a way that would cause me escalating pain, I burst into tears, even as a song began that entreated one not to despair, and to count one's blessings . . . . and I thought, "How could God do this, how can I come here and be in PAIN, how am I expected to do this, this seems so WRONG . . . .", all the while the verse went on, saying to not discourage, etcetera . . . . . and I was bawling my eyes out.
It was a tough couple of minutes, that. Of course, it isn't God that did it to me, nor even the surgeon, really. It's not like he's ever heard of this happening before, and we'll pray that it doesn't become permanent. It's not as severe as it was at three weeks, although I'm four times as many weeks out now and I still have the effect, so I'm a bit worried . . . . . I also hope it doesn't happen to the other leg; if it does, I'd assume it's a quirk of my particular anatomy, but . . . that would still suck. Again, though, I'm not going to assume it's going to repeat itself. I'm going to assume it resolves before the year is out, but keep an eye on it's progress, because at 6 months if it is still appreciable that will worry me . . . . you don't notice how many seating surfaces fall under this category until you have a problem with them.
I spoke with the Bishop, who is what another type of congregation might call a pastor, except ours is unpaid, and is "called" out of the general population of the ward, generally every five years although the period of service can vary, as seems to be the case with this one, after the meeting, about why I'd burst into tears so suddenly right as the meeting started. I'd noticed the Bishopric's startlement and attention when I'd done so (I did so silently, but they did see and notice, as they are a caring trio), as of course it would have seemed to have come out of the blue for no reason. He said, well, remind me next week, but we don't want you to be in pain; we'll pull in one of the chairs from the foyer (lobby) for you.
I was quite startled by that! These are like soft, wing chairs one might see in a house or a nice waiting area of a reception area of somewhere, and comfortable. You might see these in someone's LIVING ROOM . . . . even more so than where I just said, really. So now I'm worried that people might think, "Who is SHE so special that she gets a special chair, in the Chapel, anyway?". I even said that to somebody, a former Bishop of the ward, and he said, "Nah, we're not like that here, and we wouldn't want you to be in pain; we'll make sure that you are set up just right."
So it sounds like things will be okay, but I'm still going to stick out like a sore thumb, which is going to set off my anxiety disorders like fire alarm bells ringing, despite what the last gentleman said; I'll keep trying to repeat his kind words in my head, but I have a hard enough time with my anxieties and going there, and being in a situation that's going to make me stick out in a way that's going to cause stares and whispers and attention is, um, well . . . for a person like me, it is kind of a nightmare.
Even if he says people aren't like that. People are people, and something so out of the ordinary (and never in the years I was going more regularly did I ever see someone sitting in a soft wing chair in Sacrament Meeting) is going to cause a stir. How to handle it is the problem, and I don't have a session with my psychologist until the Tuesday AFTER next Sunday.
Oh, and to make matters worse, my husband WORKS next Sunday, so I'll be flying solo, so to speak. A neighbor will take my daughter to church for the whole thing, then run back here to get me in time for Sacrament Meeting (as the same angled padded folding chairs are the seats in Relief Society and Sunday School, I'm not sure how to handle the rest of the schedule; I can't expect them to haul around a big 'ole chair around the church just for me, and I know I can't sit on angled chairs for three hours either or I'd be screaming in pain too.)
I didn't think of the seating for the rest of the schedule issue until after we'd left church. I can't begin to impose on anyone for THAT, so I guess I'm stuck for now. We'll see. Sacrament Meeting for now, that's the most important part, being able to partake of the sacrament, anyway.
Friday, February 26, 2010
Well Whadda Ya Know . . .
I've GAINED 1.3 pounds in the last three days! Weighed in on the 23rd, then just a few hours ago, today, the 26th.
Since I had recently been getting very bored of one type of item in my diet, I'd been seeking a change, and been changing some things up the last few days, which led to a variety of other items.
I don't think that those items were necessarily more calories than what I had been tiring of, but . . . . it's one possible factor. It's also potentially the fact that the TYPES and VARIETY . . . . .
It's a good thing I've been keeping a food diary, so I can see the difference between the last three days, and the previous 7-8 days, back to when I had started tracking the food; I can use the differences to mix-and-match some of the different types of stuff from the last few days that weren't in the previous 8 day stretch, and try to come up with a combination that still has me losing weight, but at a modest rate.
There'll likely be ups and downs, but I now don't feel as panicked that things will plummet in a free fall. Still, to do what I've done the last couple of days, is still a pretty big conscious effort to make sure I'm eating as soon as I feel like I've had just enough of a rest from the last meal or mini-meal. Ie, I'm not CONSTANTLY eating, but I can't go longer than 2 hours without trying to figure out what to fix so I get enough either. Depending on the WHAT, as far as content of everything I'm eating (granted, there's been two pieces of cake in the last three days, not huge though) and depending on when I add using the exercise bike to a DAILY regimen instead of it just being every OTHER day (with this walking on my knee, without a cane, AT HOME, being a new stress on the leg, I'm concerned about adding too much, especially since, after 6 days of it, it still doesn't feel stronger, and I get wobbly partway through the day still), adding in that daily exercise bike, will burn more daily calories.
I had REALLY been concerned about adding that daily biking, when I thought I had no way of controlling the rate of weight loss. With that fear beginning to be alleviated, that also alleviates the fear that I won't get the benefit to my leg that doing daily exercise biking will add to it. I'm just not quite sure when to add it. It doesn't really hurt, it's just I wish I felt even a slight difference after almost a week of walking on the leg at home . . . . .
Even with knocking physical therapy down to two days this week, since we have a total gym and the bike (the only other machine used at physical therapy is the knee bender, NOT an aerobic exercise, but painful; extension work is done on a table, and, again, not a calorie burner), I did my squats on the home TG and then used the home exercise bike on Wednesday, since this week we started with the reduced schedule of twice a week physical therapy on Monday and Friday. So I still got the "big" exercises in, although I suppose all the "extra" effort of getting out and going to the physical location would not have been there, taking some calories burned out of the equation, but not a zillion. Still a factor, though.
On another note, I think perhaps that, since I've been living with my bipolar and other mental health diagnoses for so long, that I've forgotten the potential impact that they can have on others, the potential judgment/stigma etc. that they can produce, the potential for a reaction of, "I'm not going near THAT with a ten foot pole . . . ."
Some might say, well, if someone would be like that, you're better off, but . . . it's not that simple. I just forgot myself and rattled off that hey, here's where I blog, to someone from my past, and now I'm worried that, well . . . .
Especially since it's been some time since I used the blog effectively for mental health advocacy, fighting stigma and fostering understanding and hopefully acceptance by showing what MY struggles and experience are like, with my illnesses, tough and harsh though they are at times, especially in the blacker storms, as well as it having been some time since I've used the blog effectively to show WHO I AM, beyond illnesses both physical and mental, although those are both aspects of my life experience, especially recently, in the surgical situation.
Jeez, if that wasn't a run-on paragraph, I don't know WHAT is. I am not doing very well at focusing lately, even ON my medication for that. STILL trying to get the appeal for the MRI claim written, as well as the financial papers for special small payments that are usually unacceptable for such a large balance, for the institution that performed the MRI's, finished and mailed off with associated financial papers. MUST be mailed tomorrow. Even so I don't know how we're gonna scrape up another $50 a month even if they DO accept it . . . . and we have to work out that much of a payment on another medical bill now, too, so . . . blimey.
Since I had recently been getting very bored of one type of item in my diet, I'd been seeking a change, and been changing some things up the last few days, which led to a variety of other items.
I don't think that those items were necessarily more calories than what I had been tiring of, but . . . . it's one possible factor. It's also potentially the fact that the TYPES and VARIETY . . . . .
It's a good thing I've been keeping a food diary, so I can see the difference between the last three days, and the previous 7-8 days, back to when I had started tracking the food; I can use the differences to mix-and-match some of the different types of stuff from the last few days that weren't in the previous 8 day stretch, and try to come up with a combination that still has me losing weight, but at a modest rate.
There'll likely be ups and downs, but I now don't feel as panicked that things will plummet in a free fall. Still, to do what I've done the last couple of days, is still a pretty big conscious effort to make sure I'm eating as soon as I feel like I've had just enough of a rest from the last meal or mini-meal. Ie, I'm not CONSTANTLY eating, but I can't go longer than 2 hours without trying to figure out what to fix so I get enough either. Depending on the WHAT, as far as content of everything I'm eating (granted, there's been two pieces of cake in the last three days, not huge though) and depending on when I add using the exercise bike to a DAILY regimen instead of it just being every OTHER day (with this walking on my knee, without a cane, AT HOME, being a new stress on the leg, I'm concerned about adding too much, especially since, after 6 days of it, it still doesn't feel stronger, and I get wobbly partway through the day still), adding in that daily exercise bike, will burn more daily calories.
I had REALLY been concerned about adding that daily biking, when I thought I had no way of controlling the rate of weight loss. With that fear beginning to be alleviated, that also alleviates the fear that I won't get the benefit to my leg that doing daily exercise biking will add to it. I'm just not quite sure when to add it. It doesn't really hurt, it's just I wish I felt even a slight difference after almost a week of walking on the leg at home . . . . .
Even with knocking physical therapy down to two days this week, since we have a total gym and the bike (the only other machine used at physical therapy is the knee bender, NOT an aerobic exercise, but painful; extension work is done on a table, and, again, not a calorie burner), I did my squats on the home TG and then used the home exercise bike on Wednesday, since this week we started with the reduced schedule of twice a week physical therapy on Monday and Friday. So I still got the "big" exercises in, although I suppose all the "extra" effort of getting out and going to the physical location would not have been there, taking some calories burned out of the equation, but not a zillion. Still a factor, though.
On another note, I think perhaps that, since I've been living with my bipolar and other mental health diagnoses for so long, that I've forgotten the potential impact that they can have on others, the potential judgment/stigma etc. that they can produce, the potential for a reaction of, "I'm not going near THAT with a ten foot pole . . . ."
Some might say, well, if someone would be like that, you're better off, but . . . it's not that simple. I just forgot myself and rattled off that hey, here's where I blog, to someone from my past, and now I'm worried that, well . . . .
Especially since it's been some time since I used the blog effectively for mental health advocacy, fighting stigma and fostering understanding and hopefully acceptance by showing what MY struggles and experience are like, with my illnesses, tough and harsh though they are at times, especially in the blacker storms, as well as it having been some time since I've used the blog effectively to show WHO I AM, beyond illnesses both physical and mental, although those are both aspects of my life experience, especially recently, in the surgical situation.
Jeez, if that wasn't a run-on paragraph, I don't know WHAT is. I am not doing very well at focusing lately, even ON my medication for that. STILL trying to get the appeal for the MRI claim written, as well as the financial papers for special small payments that are usually unacceptable for such a large balance, for the institution that performed the MRI's, finished and mailed off with associated financial papers. MUST be mailed tomorrow. Even so I don't know how we're gonna scrape up another $50 a month even if they DO accept it . . . . and we have to work out that much of a payment on another medical bill now, too, so . . . blimey.
Friday, February 19, 2010
A Nice Gesture In the Search For a New Psychiatrist
On Tuesday 'round 5pm, I was making a few more calls on psychiatrists. I had started at about quarter 'till . . . why is it I wait until the end of the business day? I'm sure these offices must love this, but apparently at least one clinician takes appointments after five . . . .
One guy, his non-hospital phone number mailbox was full. That doesn't bode well, and I'd guess his practice is full. Upon calling his hospital number, I did get transferred to the floor where he practices and sees patients, but he only sees people ages 55+. I am not sure if that applies to his hospital practice, or to his other address down the street 5 blocks as well . . . .
So my third call, though technically only to the second psychiatrist of the day, was to a man's office - I've never been aware of a woman named "Frederick", although it could happen, I suppose - "Freddie?" anyone? Or perhaps as had happened early in seeing my first psychiatrist, he was either suspended (as in that case) and needed a substitute, or perhaps just on vacation, but . . .
So. I call this Frederick's office, and a nice woman answers the phone. It just seems one of those things that was meant to happen, because no one else was around, and she usually wouldn't have picked it up, because she was in with a patient. I had started to talk before I knew that, but I did not start out with, "Are you accepting new patients?" I had settled, instinctively, on a different approach, which, with the few people I had talked to at the hospital, about the other guy, before I found out about the age thing, it seemed to strike a chord, and even then, they tried to put me through to his hospital voice mail, since they didn't know what kind of patients he saw at the other address.
This approach being, a pretty brief, but emotional, without crying or fakeness, but without hopefully too much desperation, but there's obviously some in my voice, because I don't want to go through 6 months again of a search, . . . I would say something like,
It's just, from what I can remember of the last search, if you can get a bit of YOU across to the other person, they are much more likely to want to help you, especially if you aren't wasting their time. Especially if you can show that you really are a person in NEED, which I think my little speech shows .
The lady at this Dr. Frederick's ***** office answered the phone, and was apparently in with a patient as I think I may have said, and DID indeed make that sound or word of assent when I got to the part about fearing they were closed to new patients. I went on with the gist of what I had to say, with a little give and take from her, learning she was with someone, not all of what I said above said in that block, and perhaps a little more was said, but I refined it just a little above. She was VERY kind, and sincere in her desire to help. For the second time, she reiterated she was with someone, but that she had two numbers/psychiatrists to refer me to, although she couldn't know if they took my insurance. As she was pulling up the numbers, she encouraged me and said, that if they, too, were closed to new patients, to ask these psychiatrists for referrals, and to keep on going, and to not give up. Some of this was said AFTER she gave me the numbers, as the numbers came up partway through her encouraging me.
She gave me the names and numbers, spelling them out for me as one is an ethnic name, not spelling like it sounded, and then she finished her quick but professional and definitely not brushed off advice about keeping on going - she had learned from me about how it had taken me 6 months last time to find a psychiatrist. We said our final niceties and parted ways, hanging up.
That was the NICEST, most GO OUT OF YOUR WAY for a patient you aren't going to take on, interaction that I've EVER had with a doctor's office of any kind, let alone a psychiatrist's. Based on that alone, I'd recommend, should they ever open up to accepting new patients, this lady highly to anyone. Her manner, and the way she handled things, reminds me of the way that Dinah over at Shrink Rap says she handles things . . . . just the POISE of the lady on the other end, and that little extra something. The whole call was under 3 minutes, and I'm sure she did her best by the patient she had with her. She wasn't even sure why she had picked up the phone . . . . so I'm not sure if it was one of those, "meant to be" kind of things.
I then went on to call and leave a message for the one name of the two she gave me, that is on the list I printed out from my insurance company. I even had it include everybody within 50 miles, although this name isn't that far, it's not as close as I'd hoped; still, doctors tend to refer to those that they've recently known to be accepting patients, although they also know that this status can change.
Or at least I HOPE they refer to those who they know that hey, at Christmas, they told me they were still accepting new patients . . . .
Crossing Fingers! Even if it is an 18 mile drive into the middle of Salt Lake. 7 miles farther than the last one, but beggars can't be choosers. It'd be something, though, if I found one so soon, now, wouldn't it?
Addition before post goes to press, a day after post was written:
Said psychiatrist I was referred to, her office called me back, and she IS taking new patients! Woohoo!!!! They need me to come in to fill out the New Patient Information packet, and copy my Insurance card, and from there they'll make the initial appointment. At first I thought, okay, I think I can get in there in about a week to do that, and told them so. After a few minutes of thought, though, considering that she's currently scheduling appointments into the beginning of March, and I'm not sure what the surgeon is going to recommend (given my recent other health issues I suspect he'd maybe hold off on surgery, even if he ignores the knee degrees), so I thought I'd better try to get in as soon as possible.
First, I called my Mother-in-Law, to see if she could pick me & dd up and head right down there, to arrive when they get back from their lunch break. It's further away than I'd wish, but it beats the pants off of a 6 month search, and it's a sparse market for psychiatrists if you are looking for one that takes insurance, especially YOUR insurance. Psychiatry is one specialty where they tend, apparently, to sometimes or even often practice without taking any insurance at all! Because it's hard to find one, or find one that fits you well, sometimes people DO have to go out of network to find one that works for them, and/or go with one that doesn't take insurance at all and go through a hassle to get some pittance of reimbursement later from their insurance company. I'm glad that it seems I won't have to think about that road, because after having to have probably crossed out a huge chunk of providers that would see my huge MRI bill on their computers and not want to take me on, potentially, and cross off the next biggest block of psychiatrists listed that is apparently a Child & Adolescent practice, and then hitting one who is a Geriatric specialty . . . . aside from the couple of, closed to new patients . . . . well pickings on my 50 mile distance list were looking slim (although the ones over 40 miles I crossed out as too far, anyway; the choices for distance were 25, then 50, so if I wanted to include 30 miles I had to go out to 50 miles).
Not that this prospect is 30 miles out, although round trip is more than, I'll say that much.
My Mother-in-law was free that day to be able to take me and my daughter there at that time, which I am grateful for - I'll have had time to have iced my knee a bit after physical therapy, although my knee is NOT looking forward to the car ride . . . . it's a gonna hurt!!!.
I'm going to attempt to have my list of past psych meds and when and by whom prescribed, typed up - and why they didn't work out, if they didn't . . . . so I can have that handy.
Maybe surgeries too, for the medical history, as a reminder to me. Don't want to get TOO obsessive.
One guy, his non-hospital phone number mailbox was full. That doesn't bode well, and I'd guess his practice is full. Upon calling his hospital number, I did get transferred to the floor where he practices and sees patients, but he only sees people ages 55+. I am not sure if that applies to his hospital practice, or to his other address down the street 5 blocks as well . . . .
So my third call, though technically only to the second psychiatrist of the day, was to a man's office - I've never been aware of a woman named "Frederick", although it could happen, I suppose - "Freddie?" anyone? Or perhaps as had happened early in seeing my first psychiatrist, he was either suspended (as in that case) and needed a substitute, or perhaps just on vacation, but . . .
So. I call this Frederick's office, and a nice woman answers the phone. It just seems one of those things that was meant to happen, because no one else was around, and she usually wouldn't have picked it up, because she was in with a patient. I had started to talk before I knew that, but I did not start out with, "Are you accepting new patients?" I had settled, instinctively, on a different approach, which, with the few people I had talked to at the hospital, about the other guy, before I found out about the age thing, it seemed to strike a chord, and even then, they tried to put me through to his hospital voice mail, since they didn't know what kind of patients he saw at the other address.
This approach being, a pretty brief, but emotional, without crying or fakeness, but without hopefully too much desperation, but there's obviously some in my voice, because I don't want to go through 6 months again of a search, . . . I would say something like,
"Well, I'm Sara XYZABCD, and I'm looking for a new psychiatrist. Now, I'm afraid (or, "I fear") you are about to say you aren't taking any (at which point a sound of assent/agreement is usually what I hear), but I will just say that I see a psychologist for therapy, am 37, 8 weeks out from a total knee replacement, have recently lost 13 pounds in 13 days from anxiety, depression, & other reasons and really do not want my physical condition to continue to deteriorate this way, especially after such a major surgery. I see a psychologist for therapy, but my last psychiatrist never called me back when I called him about a potentially life-threatening reaction to a medication. This is also why I am not on an anti-depressant at the moment; too tricky of an issue for my GP.Now, that right there LOOKS like it takes MUCH longer to say than it actually does. It's pretty quick to say, and even for those who are closed to new patients, they get the gist that I really do need a new psychiatrist, what some of the issues are, it's not assuming failure right off the start like a straight out, "Are you taking new patients?", even though that's sort of in the second phrase of my first sentence in a different form . . .
It's just, from what I can remember of the last search, if you can get a bit of YOU across to the other person, they are much more likely to want to help you, especially if you aren't wasting their time. Especially if you can show that you really are a person in NEED, which I think my little speech shows .
The lady at this Dr. Frederick's ***** office answered the phone, and was apparently in with a patient as I think I may have said, and DID indeed make that sound or word of assent when I got to the part about fearing they were closed to new patients. I went on with the gist of what I had to say, with a little give and take from her, learning she was with someone, not all of what I said above said in that block, and perhaps a little more was said, but I refined it just a little above. She was VERY kind, and sincere in her desire to help. For the second time, she reiterated she was with someone, but that she had two numbers/psychiatrists to refer me to, although she couldn't know if they took my insurance. As she was pulling up the numbers, she encouraged me and said, that if they, too, were closed to new patients, to ask these psychiatrists for referrals, and to keep on going, and to not give up. Some of this was said AFTER she gave me the numbers, as the numbers came up partway through her encouraging me.
She gave me the names and numbers, spelling them out for me as one is an ethnic name, not spelling like it sounded, and then she finished her quick but professional and definitely not brushed off advice about keeping on going - she had learned from me about how it had taken me 6 months last time to find a psychiatrist. We said our final niceties and parted ways, hanging up.
That was the NICEST, most GO OUT OF YOUR WAY for a patient you aren't going to take on, interaction that I've EVER had with a doctor's office of any kind, let alone a psychiatrist's. Based on that alone, I'd recommend, should they ever open up to accepting new patients, this lady highly to anyone. Her manner, and the way she handled things, reminds me of the way that Dinah over at Shrink Rap says she handles things . . . . just the POISE of the lady on the other end, and that little extra something. The whole call was under 3 minutes, and I'm sure she did her best by the patient she had with her. She wasn't even sure why she had picked up the phone . . . . so I'm not sure if it was one of those, "meant to be" kind of things.
I then went on to call and leave a message for the one name of the two she gave me, that is on the list I printed out from my insurance company. I even had it include everybody within 50 miles, although this name isn't that far, it's not as close as I'd hoped; still, doctors tend to refer to those that they've recently known to be accepting patients, although they also know that this status can change.
Or at least I HOPE they refer to those who they know that hey, at Christmas, they told me they were still accepting new patients . . . .
Crossing Fingers! Even if it is an 18 mile drive into the middle of Salt Lake. 7 miles farther than the last one, but beggars can't be choosers. It'd be something, though, if I found one so soon, now, wouldn't it?
Addition before post goes to press, a day after post was written:
Said psychiatrist I was referred to, her office called me back, and she IS taking new patients! Woohoo!!!! They need me to come in to fill out the New Patient Information packet, and copy my Insurance card, and from there they'll make the initial appointment. At first I thought, okay, I think I can get in there in about a week to do that, and told them so. After a few minutes of thought, though, considering that she's currently scheduling appointments into the beginning of March, and I'm not sure what the surgeon is going to recommend (given my recent other health issues I suspect he'd maybe hold off on surgery, even if he ignores the knee degrees), so I thought I'd better try to get in as soon as possible.
First, I called my Mother-in-Law, to see if she could pick me & dd up and head right down there, to arrive when they get back from their lunch break. It's further away than I'd wish, but it beats the pants off of a 6 month search, and it's a sparse market for psychiatrists if you are looking for one that takes insurance, especially YOUR insurance. Psychiatry is one specialty where they tend, apparently, to sometimes or even often practice without taking any insurance at all! Because it's hard to find one, or find one that fits you well, sometimes people DO have to go out of network to find one that works for them, and/or go with one that doesn't take insurance at all and go through a hassle to get some pittance of reimbursement later from their insurance company. I'm glad that it seems I won't have to think about that road, because after having to have probably crossed out a huge chunk of providers that would see my huge MRI bill on their computers and not want to take me on, potentially, and cross off the next biggest block of psychiatrists listed that is apparently a Child & Adolescent practice, and then hitting one who is a Geriatric specialty . . . . aside from the couple of, closed to new patients . . . . well pickings on my 50 mile distance list were looking slim (although the ones over 40 miles I crossed out as too far, anyway; the choices for distance were 25, then 50, so if I wanted to include 30 miles I had to go out to 50 miles).
Not that this prospect is 30 miles out, although round trip is more than, I'll say that much.
My Mother-in-law was free that day to be able to take me and my daughter there at that time, which I am grateful for - I'll have had time to have iced my knee a bit after physical therapy, although my knee is NOT looking forward to the car ride . . . . it's a gonna hurt!!!.
I'm going to attempt to have my list of past psych meds and when and by whom prescribed, typed up - and why they didn't work out, if they didn't . . . . so I can have that handy.
Maybe surgeries too, for the medical history, as a reminder to me. Don't want to get TOO obsessive.
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