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Dr. Bob is Robert Hsiung, MD,
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Posted by jealibeanz on August 29, 2006, at 20:42:22
In reply to ... and my sanity..., posted by jealibeanz on August 29, 2006, at 20:15:14
So, if I were to tell him want I want him to prescribe, this would be it:
1. Keep the .5 mg Xanax t.i.d.
2. EMSAM, start at 6 mg/24 hour
3. Rozerem, 8 mg
4. Sonata (maybe? may not be long-acting enough
5. Provigil, 200 mg
I have a multitude of explanations for each, as well as different approaches for bringing up each drug, just am not sure what to do yet. I do know however, that I am taking this time out to get treatment for myself, for right NOW!
This doesn't mean me asking... what meds can you throw at me to make life easy enough that I can get through school. No. It's... what can you do to help me live my best life?
If he wants to take some aggressive approach to try to push/persuade me to continue with school, so be it, but that's not that angle I'm coming from.
I do, however, have a new and interesting resource. A new professor as of today, a PharmD! (and a verrrry nice nice nice one!) Intelligent too. I even have her email address, since she needed to send lecture notes. What a great opportunity! Yet, soo awkward... I could possibly ask her in a generic way about 1 med (although still weird), but couldn't possibly present my entire case.
Posted by bipolarspectrum on August 29, 2006, at 21:26:47
In reply to ... with properly monitered medication., posted by jealibeanz on August 29, 2006, at 20:42:22
BEANS!
where do i start, first let me say i sympathize in more ways than you could imagine...i've suffered from my weird form of bipolar for years... but somehow i managed to get into meds in ontario, canada but had to drop out due to the illness... school can be so so so hard, just overwhelming in every sense of the word...I think your best bet with ur pdoc is to make a list! I'm serious, write i feel sh*tty at the top of it... that will remind u to convey to him how awful u feel... then write down all the points u want to cover, such as school and drugs.. and refer to ur list throughout the appointment...
try to be strong, things will get better!
bps
Posted by Phillipa on August 29, 2006, at 21:47:34
In reply to Re: ... with properly monitered medication., posted by bipolarspectrum on August 29, 2006, at 21:26:47
I agree. Jelly if you're that anxious if you don't write them down you will simply forget. Just hand the list to the doc. Let him read it himself. Love Phillipa
Posted by Racer on August 29, 2006, at 21:53:57
In reply to ... with properly monitered medication., posted by jealibeanz on August 29, 2006, at 20:42:22
First, I'd strongly advise that you start one at a time -- not more than that. Truly -- minimize the variables, it makes such a difference. (I'm speaking from experience. I will never again start more than one drug at a time.)
Second, as well as writing a note of what you want to convey to your doctor, write a second note with all your symptoms -- in the order of severity. Which symptoms are the worst? Which interfere with functioning the most? Which symptoms may be creating other symptoms? (Like, the insomnia leads to increased anxiety, or foggy mind, etc.) Which can you probably live with or learn behavioral interventions to cope with? That sort of list, which I always try to do, is very helpful for you and for the doctor. And having it in writing has always helped me a lot.
Also, I know you have ideas of what medications you want to try, but here's some advice I was given a long time ago by someone very wise: let the doctor do his job. Rather than walking in with a list of what you want to try, let him make some suggestions. Let him tell you what he thinks is best for you. You can argue about it if it's not acceptable to you, but he's the one who's finished med school, after all...
Good luck!
Posted by jealibeanz on August 29, 2006, at 22:28:08
In reply to Re: ... with properly monitered medication., posted by bipolarspectrum on August 29, 2006, at 21:26:47
I do need to write down my thoughts and ideas before I go, but for me not for him. I feel fake reading from a paper with someone who I know more on a personal level. I'd do it with a stranger, but not him. Oh yeah, and this is my family practitioner, not my pdoc.
Too bad about school for you. But I hope you go back or end up in something that you enjoy. It's so hard to do if the rest of your life isn't perfectly stable. If it's a mess, well then, you're setting yourself up for torture!
Posted by jealibeanz on August 29, 2006, at 22:30:34
In reply to Re: ... with properly monitered medication., posted by Phillipa on August 29, 2006, at 21:47:34
I'm not really anxious with him. I've seen him enough now, that anxiety isn't an issue, especially since I've got my lovely Xanax. My problem is having the confidence to bring up ideas. Annnnd demand that all aspects of my problems be treated, treated well, and treated as aggressively as possible, not just sticking to baby drugs and samples.
Posted by jealibeanz on August 29, 2006, at 22:41:39
In reply to Just a very quick response » jealibeanz, posted by Racer on August 29, 2006, at 21:53:57
Well.... I know from past experience, and experience/errors with my family members, it's best with him if I do the research and make suggestions:)
My straight out list of meds was a joke! I'm not gonna walk in and demand that, but it's also not too far off.
OK, so personally, the depression is MY main concern. I'd like to suggest EMSAM, but saying either that I read about it in my texts, heard it mentioned in class and looked up the prescribed info, or came across it in a journal while writing a paper. All, actually are true.
His main concern, when I tell him the insomnia has not improved will be to treat that. I don't reallly care what he does. I just want him to do something other than what we're doing know.
The Xanax for anxiety is fine. We don't need to touch it.
I'd like to mention that I've experience this type of "leaden paralysis" depression before, when I was a freshman. I slept up to 18 hours a day, it was never refreshing, and I always felt terrible. It's the type of thing I've felt for the past 3 weeks. I worry becuase it lasted almost a year before! I took Provigil ((which helps with the fatigue, but doesn't cause axiety, depressiom, or insomnia, briefly, for 1 month, to relieve the fatigue (not dianosed w/depression!)), but then transferred college and had no doctor.
I'm really only asking about one new addition. I'm telling him of one that's helped partly reduce symptoms in the past, and leaving the rest up to him.
Posted by Phillipa on August 29, 2006, at 22:42:57
In reply to Re: ... with properly monitered medication., posted by jealibeanz on August 29, 2006, at 22:30:34
Funny my pdoc always brings up a few choices and leaves it up to me what I'd like to try. I always ask her what she thinks I should do. But she wants the final decision from me. She finds patients are more compliant with their meds if they have made the final choice. Makes sence to me. Love Phillipa
Posted by finelinebob on August 29, 2006, at 23:26:25
In reply to Re: Just a very quick response, posted by jealibeanz on August 29, 2006, at 22:41:39
Well, I'd say write up the explanation of how you feel and write up the meds you'd like to be on -- because I'd hope you absolutely overwhelm your GP. I don't say that to be mean, and it's hard to move on to a different, new relationship from one you've grown to feel some trust and comfort with ... enough to break down the walls and open up.
But that many meds is way beyond a GP's expertise, no offensive to your GP. If you're going to take this seriously and take control and be honest, then get the best help you can. Get a recommendation from your GP of someone they trust, and someone who is willing to have an open mind about treatment.
I've had three PDocs. The first was very cautious and traditional and by the time I built up a trusting relationship with him, I began to realize he wasn't being aggressive enough with my treatment ... but throwing away that trust was hard. The decision was taken out of my hands -- I had to move out of state. The new PDoc (recommendation of a nurse at my parent's GP's office who had several family members seeing him) was far more open-minded and made me rethink the biological side of my disorders. When I got back to NYC, I went with the most aggressive, knowledgeable PDoc my T knew, and as much respect and caring I have for my GP -- he's a kind and loving, caring soul who is absolutely the best medical doctor I've ever had in any specialty -- this PDoc knows sooooo much more than my GP and he is sooooo right for me.
You might not be able to go to a PDoc ... I don't know. Lots of reasons - money, trust, being mentally ready for that step. And if that's where you are, then get the best help you can from the resources you have. But if you can take the step, ask for a referral and not the scripts.
My $0.02
flb
Posted by jealibeanz on August 30, 2006, at 1:21:29
In reply to Re: ... with properly monitered medication. » jealibeanz, posted by Phillipa on August 29, 2006, at 22:42:57
Yeah, in a way I'd say my PA and doctor have always left it up to me. I have been non-compliant in the past, although I thought I was helping... I made my own Effexor titrtion, starting and stoping other meds w/o telling anyone, etc. They're realizing that if they trick me into thinking I nearly wrote the prescription, I could actually do what I'm told!
Posted by jealibeanz on August 30, 2006, at 1:24:24
In reply to Re: Just a very quick response » jealibeanz, posted by finelinebob on August 29, 2006, at 23:26:25
I really don't think I'm able to get a pdoc, I went to the only one possible, and won't/can't see him again.
Do you think it's pointless to see my GP? EMSAM is way over his head?
Posted by finelinebob on August 30, 2006, at 1:40:36
In reply to Re: Just a very quick response, posted by jealibeanz on August 30, 2006, at 1:24:24
> I really don't think I'm able to get a pdoc, I went to the only one possible, and won't/can't see him again.
>
> Do you think it's pointless to see my GP? EMSAM is way over his head?Only your doc can answer that.
For instance, I shared with my GP about how my HMO wouldn't pay for 10mg of Focalin 2x per day. He pulled out his little med book and got rather angry (which he tends to do wrt HMOs) and said that is the standard dosage and they were screwing me.
So, he can look up meds in his book, read about indications and contraindications, but whether he'll know about the subtleties involved is a different issue.
For my current PDoc, these sorts of subtleties include:
-- given my response to Zyprexa (goods and bads), giving me a trial on Abilify ... why Abilify over any other atypical anitpsychotic and why he didn't try any other when it didn't help
-- my description of my anxiety, why he felt klonopin was right for me but quadrupled my dosage, and why he felt a stimulant as strong as Focalin wouldn't be a problem.-- his knowledge of how much HMOs are willing to pay, and writing up scripts that will last me 2-3x what I need so my co-pays are half to one-third of what I should be paying. Plus, it let him figure out how to get me back on Focalin when the HMO said no to it the second time he prescribed it on my first trial for that med.
I'm not saying every PDoc will be that "crafty" or that GPs won't. The question is how knowledgeable your GP is outside the "book". Mine knew he was limited, so way back about 10 years ago when I started up on meds as soon as there was an "anomaly" he got me to a specialist.
Posted by Racer on August 30, 2006, at 1:42:46
In reply to Re: Just a very quick response, posted by jealibeanz on August 29, 2006, at 22:41:39
>
> OK, so personally, the depression is MY main concern.That's actually an example of what I mean when I suggest writing down which symptoms are most bothersome for you. Saying "depression" isn't a lot of information: what does depression look like for you? Which symptoms are most problematic for you?
You mention leaden paralysis later in your post, but that's not something I generally experience with depression. I get things like waking up at 4AM and not being able to get back to sleep. I stop talking. I don't sleep 18 hours per day, but will sleep in short bursts of a couple of hours at a time, and be even more miserable because of it.
With all those different symptoms, all called "depression," it's important to let the doctors know what sorts of symptoms you have. If they're treating you for my kind of depression, for instance, that's not likely to do you a lot of good, right? (Just like treating me for more atypical depression wouldn't necessarily help...)
Anyway, that's just to clarify what I was suggesting.
Good luck.
Posted by jealibeanz on August 30, 2006, at 1:57:13
In reply to Re: Just a very quick response » jealibeanz, posted by finelinebob on August 30, 2006, at 1:40:36
Probably down the road, I'd imagaine I'd end up at a specialist, however, right now, he's what I've got.
I'm willing to drop the Provigil issue. Maybe mention it in passing, but not push for it unless he wants to. I would think/hope even it he could/would refer me to a pdoc in my area who takes my insurance and new pts (and I'm not sure this is possible) , there would certainly be a couple months of a wait time. I'd think he'd treat me in the mean time.
But really, I've been there enough with anxiety/depression/insomnia/ADHD and puzzled them at times (probably my own fault due to lack of compliance and poor follow and report of symptoms), and still have never had the idea of a pdoc suggested.
If I somehow get through with the EMSAM idea, enough for him to latch on and try it, how often do they normally see patients? Every week for BP, ect? Any suggestions on how to word my push for EMSAM?
Posted by Ts6639 on August 30, 2006, at 8:02:00
In reply to Re: Just a very quick response » jealibeanz, posted by finelinebob on August 29, 2006, at 23:26:25
There have been some great postings. The only thing I have to add is that I think it is important to put down your false front and let the doctor SEE what is going on with you. I always wanted to maintain a good face, while I felt like I was dying inside and it got me know where. A doctor isn't a mind reader. He works with what he is presented with. Good luck.
Posted by jealibeanz on August 30, 2006, at 8:36:02
In reply to Re: Just a very quick response, posted by Ts6639 on August 30, 2006, at 8:02:00
Did you have more luck when giving up the fake front.
I think my message is clear enough when I say I'm not going back to school. I'd rather just treat this, get some sleep, and think about a new career if I start feeling better.
Posted by bassman on August 30, 2006, at 8:40:11
In reply to Re: Just a very quick response, posted by Ts6639 on August 30, 2006, at 8:02:00
Ditto. Don't let the real stigma of mental illness keep you from reaching out to the doc as much as possible. I did the same thing (hid my emotional pain) from a pdoc more that I should have for three years of Hell. Fortunately, I got a new GP who had me figured out in 10 minutes and aggressively helped out. I owe her about 80% of the good things that have happened in my life in the last 7 years. We moved away...I should write her another note thanking her for all she did for me.
Posted by jealibeanz on August 30, 2006, at 10:48:48
In reply to Re: Just a very quick response, posted by bassman on August 30, 2006, at 8:40:11
I have hopes that I could be such a success story, like yourself. I always show such promise and glimpses of improvement and potential. Yet, there just seems to be something missing that I can't quite control myself. I need help, I just feel badly that I'm not tough enough to muster through my life. Lord knows I've toughed out a whoollle lot to get where I am today. But a stable career and full-fledged adulthood is going to require me to be more function and stable. I won't be able to just sleep for months at a time and stumble to class barely awake or motivated.
I feel bad that I may end up completely altering my career path and ultimately my life, within the next few days, due to fairly minor mental disorder which could have been treated years and years ago. I wouldn't be in the situation I am today. I know we all have to start somewhere. I just wish I would have started this process aggressively in my younger years.
Posted by bassman on August 30, 2006, at 12:00:01
In reply to Re: Just a very quick response, posted by jealibeanz on August 30, 2006, at 10:48:48
You're breaking my heart. I can't tell you how many people I know that have given up their career paths or done something that was not consistent with their talents because of a mental illness. And then they torture themselves about it later in life...please, please don't do anything that would preclude your professional happiness in the future, if you possibly can. Your future is so important...
Posted by jealibeanz on August 30, 2006, at 12:56:44
In reply to Re: Just a very quick response, posted by bassman on August 30, 2006, at 12:00:01
The idea kills me too. It's just such a terribly difficult thing to keep up with, or want to keep up with, due to the lack of energy and desire to actually be in this world right now.
If I let it be know on Saturday that I'm done with school due to this illness, I bet he'll do everything in his power to keep that from happening. That sounds so maniupulative a needy though. It's not his problem. This would be almost like I've got something to hold over him. Like a threat. I don't want that.
Posted by saturn on August 30, 2006, at 13:00:38
In reply to Last Ditch Effort to Save My Life, posted by jealibeanz on August 29, 2006, at 20:13:13
Hi Jealilbeanz,
Is your babblemail purposely turned off? I'd like to send you a private message or if you'd like you may babblemail me. You are not alone...Saturn
Posted by jealibeanz on August 30, 2006, at 13:35:22
In reply to Re: Last Ditch Effort to Save My Life » jealibeanz, posted by saturn on August 30, 2006, at 13:00:38
I just turned it on.
Posted by jealibeanz on August 30, 2006, at 13:40:46
In reply to Re: Last Ditch Effort to Save My Life » jealibeanz, posted by saturn on August 30, 2006, at 13:00:38
BTW, you all are great for helping me and offering advice at such a difficult time in my life. I truely appreciate it.
If I ever have success with a med, I promise I write about it, not disappear.
Posted by exquilter on August 30, 2006, at 15:11:23
In reply to Re: Last Ditch Effort to Save My Life, posted by jealibeanz on August 30, 2006, at 13:40:46
Have you talked to disabled student services at your school to see whether you can arrange to take a lighter course load? Maybe you can continue your career path at a slower pace instead of giving it up. Your MD may be able to help by a recommendation for this and by confirming your diagnosis.
Exquilter
Posted by linkadge on August 30, 2006, at 17:28:26
In reply to Re: Last Ditch Effort to Save My Life, posted by exquilter on August 30, 2006, at 15:11:23
I can relate, though in my case it was the opposite. Meaning that yes I did want to quit school, but it was the difficulty of school that caused the depression, not the depression which caused the difficulty of school.
Treatments just made the work harder, and subseqently made me more depressed.
It was stupidity that kept me going. Depression for me, was a normal sign that the work was too hard, and that I didn't have the skills. But nowadays, thats not the case. I was told I was depressed because I was "chemically imballanced", and sure that sounded great and I embraced that possibility, but it didn't have me facing the truth, which was I was in over my head.
Not trying to sound negative, but just thought I'd share my own angle.
Linkadge
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