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Re: pre-consult checklist?

Posted by polarbear206 on January 24, 2010, at 23:47:07

In reply to Re: pre-consult checklist?, posted by bleauberry on January 24, 2010, at 6:06:47

> > My doc's own belief is that my condition is 60% psychological, 40% biological--hpa dysregulation of some sort.
>
> You would need an Integrative MD, Alternative MD, or Naturopath Clinician to accurately test suspected HPA dysregulation and try treatments. That said, the proper meds can restabilize the dysregulation, the wrong meds can either cause it or make it worse. My opinion, purely unscientific, is that anything focused on serotonin without equal balance to NE will eventually cause HPA dysregulation, despite initial acute normalization shown in clinical studies.
>
> >
> > What I want is a more stable, higher
> > baseline with less susceptibility to triggers and hyper-arousal.
>
> Me too. I would set the goal even higher...total remission. Don't cut yourself short. Tell the doc you insist on remission.
>
> He suggested, perhaps the anticonvulsants
> > lamical or lithium (600 which seems way
> > too high!). I'd like to jettison my 50mg of pristiq.
>
> Lithium. It has the longest track record, and I like that it is a natural substance. Lamictal's benefits, if they happen, usually do not last but 6 months to a year in longterm studies. I'm sure someone could debate successfully on this and there will always be isolated success cases, but in general I personally do not see lamictal as a longterm treatment. It just isn't supported in literature and I hardly ever see it in the real world. Lithium, different story. I do not believe shooting for a predetermined dose based on the general pattern seen in larger populations is a good strategy...start low...100mg-300mg...and feel it out from there. Listen to your body to find the right dose.
>
> >
> > He is against AP's in my case. And kinda
> > Blew off parnate (due to washout).
>
> Too bad. That is ruling out some excellent candidates. If I were you, I would ask him for specific detailed reasons why they are being ruled out. I would challenge him on that. After all, me the paying customer, and me owning my body, and me being the boss of what I ultimately do with my body, I have the right to ask questions, challenge ideas, and negotiate for the treatment I believe in. His ideas are important in that mix, but should not by any means be final.
>
> You can always bring in literature from pubmed or the worldwide web to support any of your own ideas. The more the better. For example, trying to "sell" the idea of Savella+Risperdal, or Zoloft+Nortriptyline, or Prozac+Zyprexa, would be strongly supported by the large body of evidence on these things.
>
> >
> > So, I'm bringing:
> >
> > mood / med chart
> >
> > list of somatic symptoms
> >
> > list of all psych meds ever taken plus current supplements and herbs
> >
> > concise history of traumas in addition to usual treatment summary and dates of onset
> >
> > a trusted friend-- possibly my husband--could this be helpful, having someone quietly sit in with me?
> >
> > Should I bring a recorder in case that is permitted?
> >
> > Anything else I should or shouldn't bring?
>
> I'm not sure about the recorder thing. Never thought about that. But everything else, definitely. The partner/witness/spouse is great strategy for a variety of reasons.
> >
> > I'm feeling o.k. about this.
> >
> > fb
> >
>
> I hope it goes real well!
>
>
I think your well prepared. Revolution Health thread on Lamictal ratings are mostly positive. Keep in mind that I've been on it over 10 years with great success. Good luck with whatever plan of action you and your doc decide to start with. Keep us posted. :)


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poster:polarbear206 thread:934843
URL: http://www.dr-bob.org/babble/20100122/msgs/934932.html