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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by utopizen on November 17, 2002, at 17:23:41
Almost every visit, I ask my doc for Klonopin. He says no, or every few months he "caves in" and gives me 15 .5mg for prn dosing.
Really, I'm serious this time, it's been over a year of trying everything, and I just want to give up and go for the Klono. I'm on Effexor 225, and it does nothing, nothing since 9/15 when I started it. He said he would probably have to combine it with something else if it didn't work, but I just know even if he does this it won't do a thing, I mean I've tried so many meds with no luck.
How do I let him know politely I am going to see another doc if he doesn't let me go on Klonopin daily?
Posted by JonW on November 17, 2002, at 18:37:10
In reply to How do I let me doc know I'm not joking this time?, posted by utopizen on November 17, 2002, at 17:23:41
utopizen,
If I were you I would send him a fax before your next appointment explaining yourself. You seem to express yourself very well and it will make the appointment go much smoother. I wouldn't threaten him to prescribe it, but I think he'll be more receptive if you remind him why it makes sense to give Klonopin a try.
Regardless of his response, you may not want to rule out seeking out another pdoc. If he isn't that open to using benzos when they are justified, he may not be as experienced as you think. Another question you may want to ask him in the near future (if you haven't gotten better) is if it would make sense for him to refer you to someone with more experience treating people like you. It's a legitimate question, and certainly not an offensive one to a professional. I hope things work out for you.
Jon
Posted by Alan on November 17, 2002, at 21:57:20
In reply to How do I let me doc know I'm not joking this time?, posted by utopizen on November 17, 2002, at 17:23:41
> Almost every visit, I ask my doc for Klonopin. He says no, or every few months he "caves in" and gives me 15 .5mg for prn dosing.
>
> Really, I'm serious this time, it's been over a year of trying everything, and I just want to give up and go for the Klono. I'm on Effexor 225, and it does nothing, nothing since 9/15 when I started it. He said he would probably have to combine it with something else if it didn't work, but I just know even if he does this it won't do a thing, I mean I've tried so many meds with no luck.
>
> How do I let him know politely I am going to see another doc if he doesn't let me go on Klonopin daily?
================================================
I think JonW gives good advice. You have no other alternatives as far as docs go? If I found a drug that worked as well as klon as you say it does ( I take klon full time) I would run, not walk to a doc that listens to what you tell them.Look at it this way. Is it more trouble to deal with a benzophobic doc or live with the misery of your symptoms? Perhaps that will make it more clear in your mind. Trying to convince docs is not always a productive endeavour.....as I found out the hard way after 2 docs. Second and third opinions are common in medicine every day. Why should one with psychiactric disorders be viewed any differently??? That's about as discriminatory as it gets....and from a Pdoc?
Alan
Posted by AnneL on November 18, 2002, at 0:37:04
In reply to How do I let me doc know I'm not joking this time?, posted by utopizen on November 17, 2002, at 17:23:41
Utopizen,
I do not know where you live, but getting benzos from many, many different type of docs is no big deal. Why are you stuck on trying to wrangle benzos out of a pdoc who is obviously uncomfortable prescribing them or prescribing them to you? I take Klon 1 mg. every day and have done so for almost 2 years. I get 90 pills every three months from with Rx from my doc through my mail-order pharmacy benefits provider.
$5.00 for 90 generic tabs. It is no big deal. It is a helpful medication. It works great and although I have some issues with the "dumb" side to this med (I tend to get the morning "dummies")
it gets better after a few cups of coffee. I have also been on Effexor 225 for the last 2 years and just increased by Effexor to 262.5 mg. daily (225 plus a 37.5 cap). Go for it and get on with it!
:) Anne
Posted by utopizen on November 18, 2002, at 1:43:32
In reply to Answer: Go to another doctor » utopizen, posted by AnneL on November 18, 2002, at 0:37:04
My camps *dermatologist* heard me explain the situation, and he immediately said "then go see an on-campus p-doc""
this guy I'm seeing I walk 30 minutes away from campus to see....
Posted by Squiggles on November 18, 2002, at 8:19:12
In reply to How do I let me doc know I'm not joking this time?, posted by utopizen on November 17, 2002, at 17:23:41
I am of the possibly controversial opinion
that all doctors are the same in their
practice--that's because they work under
higher doctors and supervisors and all follow
the same rules. At least, i believe that
is the case in Canada. So going from one
doctor to another will not give very much
of a difference if they are doing and following
by the book.Squiggles
Posted by utopizen on November 18, 2002, at 10:05:50
In reply to Re: How do I let me doc know I'm not joking this time?, posted by Squiggles on November 18, 2002, at 8:19:12
> I am of the possibly controversial opinion
> that all doctors are the same in their
> practice--that's because they work under
> higher doctors and supervisors and all follow
> the same rules. At least, i believe that
> is the case in Canada. So going from one
> doctor to another will not give very much
> of a difference if they are doing and following
> by the book.
If that were the case, Klonopin would not be in the top 200 drug listing.Besides, I've already been told by my college's infirmary to stop seeing my p-doc off-campus and see an on-campus p-doc so I can get Klonopin.
I go to school in Boston.
> Squiggles
Posted by Alan on November 18, 2002, at 10:07:59
In reply to Re: How do I let me doc know I'm not joking this time?, posted by Squiggles on November 18, 2002, at 8:19:12
> I am of the possibly controversial opinion
> that all doctors are the same in their
> practice--that's because they work under
> higher doctors and supervisors and all follow
> the same rules. At least, i believe that
> is the case in Canada. So going from one
> doctor to another will not give very much
> of a difference if they are doing and following
> by the book.
>
> Squiggles
============================================
That's certainly NOT what I've found. Quite the contrary. Perhaps in a more socialised system that Canada, Australia and certainly moreso Britian has, this is possible in many cases....but...there is hope for a patient that want's to be treated with more than the cookie cutter mentality, by doctors under the thumb of these "HMO's" or the thumb of the commercialism of "ssri's good, bzds bad" mentality.Alan
Posted by Squiggles on November 18, 2002, at 14:04:42
In reply to Re: How do I let me doc know I'm not joking this time?, posted by Alan on November 18, 2002, at 10:07:59
It would seem to me that if there is
great variation in prescription and medical
treatment, the doctors would be fired for
not following the CPA or APA or hospital
standards -- it would be a great deviation
from the accepted practice and rounds they
have been through.Squiggles
Posted by utopizen on November 18, 2002, at 15:36:53
In reply to Re: How do I let me doc know I'm not joking this time? » Alan, posted by Squiggles on November 18, 2002, at 14:04:42
> It would seem to me that if there is
> great variation in prescription and medical
> treatment, the doctors would be fired for
> not following the CPA or APA or hospital
> standards -- it would be a great deviation
> from the accepted practice and rounds they
> have been through.
>
> SquigglesGiving a benzo for anxiety is not a deviation from prescription trends among the doctor's peers. What on earth would a doctor give besides a benzo when it has been proven for over a year with 1/2 a dozen different drug trials that SSRIs, SNRIs, Buspar, Neurontin, and Inderal don't work? Plenty of doctors don't even try anything before giving out benzos, this doctor would in this case be MORE than covered if he was audited, since he's tried EVEN EXPERIMENTAL alternatives to therapies.
Remember that benzos are among the most prescribed drugs in this country, top 50 or so at least... and considering my treatment resistance, I am obviously way more of a minority among patients in trying alternatives before trying a benzo. Most doctors are not this patient with trying non-benzos first, for sure.
Posted by Squiggles on November 18, 2002, at 15:50:39
In reply to Re: How do I let me doc know I'm not joking this t, posted by utopizen on November 18, 2002, at 15:36:53
Then you agree with me that the appropriate
prescription is a uniform practice - you only
disagree with "what is the appropriate prescription";
but if you say that benzos are most likely to
be prescribed by any sane doctor, you are
contradicting yourself.Squiggles
Posted by utopizen on November 18, 2002, at 16:37:02
In reply to Re: How do I let me doc know I'm not joking this t » utopizen, posted by Squiggles on November 18, 2002, at 15:50:39
> Then you agree with me that the appropriate
> prescription is a uniform practice - you only
> disagree with "what is the appropriate prescription";
> but if you say that benzos are most likely to
> be prescribed by any sane doctor, you are
> contradicting yourself.
>
> SquigglesI'm afraid I do not agree with you at all.
I was trying to explain that the range by
which what a doctor prescribes is much
broader in its spectrum than you
appear to make it out to be.When it becomes illegal is when, let's
say, a doctor is giving out Desoxyn
(methamphetamine HCL) to patients
for stomach ulcers, when none of their
peers are doing that.But fewer than 1% of stimulant prescriptions
are for Desoxyn for ADD... and this is still
within the spectrum of according to
peer trends. And benzos, well, that's
not even close-- way more benzos
are given out than Desoxyn, since
Desoxyn is one of the least prescribed
drugs in the country, and benzos are
among the most.So if you think giving a benzo for
anxiety is out of peer prescribing
trends, certainly you would think
Desoxyn is out of peer prescribing
trends, and in that case, how come
doctors who give out Desoxyn to
ADD patients aren't arrested?
Posted by Squiggles on November 18, 2002, at 16:49:18
In reply to Re: How do I let me doc know I'm not joking this t, posted by utopizen on November 18, 2002, at 16:37:02
It is not a question of how many benzos
are given out, so much, as "what for";
About 20 years ago, when i was dx'd bipolar,
GAD was all the rage, and so was the prescription
of clonazepam for GAD; Somebody, probably
the manufacturer convinced the medical
community that clonazepam was good for
GAD, unlike Valium, and the other 100 benzos;Then, gradually the whole medical picture shifted
and they realized that anxiety need not necessarily
go along with depression (bp or up); so a new theory
came up - that bipolar disorder was a species
of epilepsy; therefore clonazepam could STILL,
indeed MUST still be prescribed as it was an
anticonvulsant. This must have been a real
joy for Hoffman La Roche (whom i believe is the
maker of this drug, primarily for epilepsy).This sounds very fishy to me, but after
some time on the net i am beginning to see
the trends in "spin-offs" as a marketing
scheme, not only in drugs, but cosmetics and
other products as well.Strangely enough Valium became demodee. This too
would have been good for GAD - infact, any long-term
benzo would.So, with all this shifting around; what do you
think the doctors do--i doubt very much that
you will see them joining the likes of the anti-psychiatry
movement and marching with placards in front of
BigPharm. Rather, i think they follow the instructions
which have trickled down from the meetings between
doctors and pharmaceutical companies and other
agencies on what's up;So the point of this is that the doctor is really
at the mercy of these movements and must follow along.Squiggles
Posted by JonW on November 18, 2002, at 18:24:30
In reply to Re: How do I let me doc know I'm not joking this t » utopizen, posted by Squiggles on November 18, 2002, at 16:49:18
Posted by Alan on November 18, 2002, at 19:32:12
In reply to Not a top pdoc... (nm) » Squiggles, posted by JonW on November 18, 2002, at 18:24:30
I think JonW makes a good point.
In any profession there's the usual median of competant but relatively uninspired part of the workforce. Translated to the medical profession, those that don't treat individuals as individuals and are content to take their instructions and treatment modalities from whatever comes their overburdened way.
My guess would be that there are the passionate doctors that do care about individuals (as opposed to "cases") ranging in the upper 10th percentile. There are probably many that exist right there within the constraints of the NHS, HMO's etc but have nowhere to go with it due to these monstrosity, cookie cutter conglomorates.
I personally had to go outside of this sphere to find an independent acting, compassionate, and very bright pdoc and suffered many years unnecessarily before find one of them. (It cost me in $$$ and time and suffering immensely to get there so no lines please about how privilidged my American heritage somehow "provided" me with this "priviledge").
They're out there alright. The road to finding them is often a hard one often found by either sheer luck or doggedly stubborn research on the patient's part.
The problem is that those with disorders don't often have it in them to survive the quest and throw up their arms assuming that the present treatment they're on is the best that psychiatry has to offer them.
That's why these bboards are invaluable - a worldwide sounding board for the "secrets" of mental illness that have before gone unsaid because of the stigma surrounding mental health and keeping it in the family or amongst best friends, etc.
But back to the point. There are probably 10 at the most in 100 that will know their stuff and have a combination of compassion and intuition to make a meaningful difference in their patient's lives. The rest are probably doing more harm by their lack of engagement - those in the remaining 90 percentile.
One other thing.
Someday, someone, somewhere is going to explain sufficiently why benzodiazapines are not offered to the patient on an equal footing in the first place with all of the other forms of chemotherapy available. The overprescription of Valium over 30 years ago is getting to look like a fairly obselete excuse in the years 2002 - 2003.
I understand the overall life-cycles of psychotropic drugs but this pushing aside of bzds is being driven by what I think could reasonably be included in the next DSM manual V as "benzophobia". Ironically, the idealological docs out there would have to be put on a bzd and receive psychotherapy themselves for their "phobia".
Alan
Posted by Squiggles on November 18, 2002, at 20:38:02
In reply to Re: Not a top pdoc... » JonW, posted by Alan on November 18, 2002, at 19:32:12
Heh,
Another phobia i can think of that the DSM IV
might include, is iatrogenic-induced iatrophobia.If a list of the 10% of the doctors you refer to as having
the "magic touch" with some esoteric, astute
judgement, is available, i strongly suggest that you do not
reveal their names. As great as this site is for
sharing information you would not be doing
the readers a favour, nor the doctors. Because
if you do, the number of patients that may
start flocking to them, may actually throw
them back into the sludge pile of the
90% mediocres, just from the surplus of patients.Squiggles
Posted by utopizen on November 18, 2002, at 21:00:34
In reply to Re: Not a top pdoc... » JonW, posted by Alan on November 18, 2002, at 19:32:12
Yeah, when my dermatologist tells me to switch docs so I can get benzos, I think I realize I'm not crazy for wanting them...
I just wish I was more assertive, rather than just allowing the doc to poo-poo everything I say as if I'm trying to be a chemical super-hero with scripts. I'm just trying to be normal, darn it. He thinks I'm trying to over-compensate for my past. Geez.
Posted by JonW on November 18, 2002, at 21:30:32
In reply to Re: Not a top pdoc... » JonW, posted by Alan on November 18, 2002, at 19:32:12
> I think JonW makes a good point.
I must agree. :-)
> I understand the overall life-cycles of psychotropic drugs but this pushing aside of bzds is being driven by what I think could reasonably be included in the next DSM manual V as "benzophobia". Ironically, the idealological docs out there would have to be put on a bzd and receive psychotherapy themselves for their "phobia".
LOL! I thoroughly enjoyed this one!
Jon
Posted by Alan on November 18, 2002, at 21:32:44
In reply to Re: Not a top pdoc... » Alan, posted by Squiggles on November 18, 2002, at 20:38:02
> Heh,
>
> Another phobia i can think of that the DSM IV
> might include, is iatrogenic-induced iatrophobia.
>
> If a list of the 10% of the doctors you refer to as having
> the "magic touch" with some esoteric, astute
> judgement, is available, i strongly suggest that you do not
> reveal their names. As great as this site is for
> sharing information you would not be doing
> the readers a favour, nor the doctors. Because
> if you do, the number of patients that may
> start flocking to them, may actually throw
> them back into the sludge pile of the
> 90% mediocres, just from the surplus of patients.
>
> Squiggles
>
>
============================================
Well I don't know about that but...Unfortunately, doc shopping from educated consumers is probably becoming more common these days now that we're sharing so much information freely amongst ourselves. I would have never thought to be inspired to wade through the muck of the mediocre docs that I was dealing with 5 - 10 years ago if it weren't for patient informational/advocacy sites like these!
I hear of many telling their docs what THEY want to do next. After all, the patient is the boss and the doc IS the employee...except on the psych ward.
Sadly, those that are disabled enough are not able to be assertive for their own care. All we can do is offer the best individual and statistical information that we can get our hands on rather than in the old days....nod approvingly to the doc acrooss the table because they were in sole possesion of the "interpretation" of the evidence.
It's a revolution really. That's the good news.
Alan
Posted by Squiggles on November 19, 2002, at 6:20:02
In reply to Re: Not a top pdoc..., posted by utopizen on November 18, 2002, at 21:00:34
"Chemical super-hero" hee hee hee - first
thing to read this morning... nice :-)
Hey, can i have so Drano with my coffee please?Squiggles
Posted by Squiggles on November 19, 2002, at 6:25:52
In reply to Re: Not a top pdoc... » Squiggles, posted by Alan on November 18, 2002, at 21:32:44
Alan said:
> "Sadly, those that are disabled enough are not able to be assertive for their own care. All we can do is offer the best individual and statistical information that we can get our hands on rather than in the old days....nod approvingly to the doc acrooss the table because they were in sole possesion of the "interpretation" of the evidence.
>
> It's a revolution really. That's the good news."
But if we are disabled as you say, then how can
you trust yourself to choose the "proper" doctor?
Maybe in the condition you are in you will make
a graver mistake and go for one of those California
birds of paradise.Squiggles
This is the end of the thread.
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