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.