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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Aphrodite on August 24, 2004, at 21:12:03
After several months of therapy, I've recently begun opening up about several traumatic experiences, and as happens with wound-ripping, I have gone from CEO Aphrodite to weepy, mess Aphrodite. It's been hard to revisit things repressed for so long. So, as I have come to rely and depend on my T and even make an emergency call or two despite my worries about being a burden, I got shocked into reality when he asked me to go to a pdoc. I've been struggling with this on several levels. The most hurtful thing is that I feel like now that I'm letting everything out, he wants to shut me up. I feel like it's too much for him, and he does seem to excessively worry. I know this is probably not the case, but the timing is rather suspect. Second, I'm afraid of meds causing me to lose any joy I might have in addition to dulling the pain.
Also, I have no idea what to expect in a psych evaluation. It's been a week or two of trying to even find one whose recommended and who takes new patients. I've got an appointment with one who is just a shot in the dark. (He's a DO instead of an MD -- does anyone know the significance of that?) What can I expect? Does the pdoc automatically want to talk with the T? The idea of that is very troubling to someone like me. I can already hear the snickering.
Sorry, bad day. Thanks for any help.
Posted by Dinah on August 24, 2004, at 21:45:55
In reply to Psych eval woes -- any insight?, posted by Aphrodite on August 24, 2004, at 21:12:03
I've had initial appointments with four or five psychiatrists for meds. It's really not bad. They generally just take a cursory life history, check out your current functioning, followup on any words you might use that might indicate a specific disorder (like if you say "repetitive thoughts" they follow up with ocd questions - stuff like that). They'll probably ask your medication history. If I remember correctly, the intial interview usually took an hour or maybe a bit more.
It's nothing like the sort of thorough evaluation a psychologist might give you with a battery of tests.
Then they'll probably suggest the simplest medication solution to your problem and give that a trial, and follow up with you.
I don't remember any of the initial visits as being particularly unpleasant. I didn't choose to continue with most of them (obviously) for various reasons.
My current pdoc has no interest whatsoever in talking to my therapist, but I understand that isn't usual operating procedure. My first pdoc worked with my therapist at the same clinic, and they talked altogether too much, so I can understand your concerns. I think many are somewhere in the middle.
Your therapist just wants you to feel better. If he's any good sort of therapist at all, he won't refer you to a doctor for meds because *he* needs it, he'll refer you because he thinks it will help you, at least at the moment. And meds do put a floor on the pain, gives you a safety net, so that you can do therapy more effectively, in some situations. Don't feel that it's any reflection on you. My therapist saw my OCD at once, and referred me to a pdoc almost immediately because there are very effective OCD meds out there. I eventually quit the main one, because I had used my time on them to discover minimal medication methods of dealing with it. But I'm not sure I'd have had the distance to do that if I weren't on meds.
Posted by lucy stone on August 24, 2004, at 22:45:17
In reply to Psych eval woes -- any insight?, posted by Aphrodite on August 24, 2004, at 21:12:03
A DO is a Doctor of Osteopathy whereas an MD is a Medical Doctor. Osteopathy is sort of like a combination of mainstream medicine and chiropractic, they do all the stuff MDs do but also do spinal manipulations and that kind of thing. Their training is more whole-body than MDs. They are eligible for the same residencies that MDs are and their training is considered equlivalent although with a bit of a different emphasis. If the pdoc you are thinking of seeing is board certified, s/he had the same training and took the same board exams as a pdoc with an MD. You shouldn't let it concern you a bit.
Posted by shortelise on August 25, 2004, at 0:02:23
In reply to Re: Psych eval woes -- any insight?, posted by lucy stone on August 24, 2004, at 22:45:17
Meds didn't dull any joy for me. In fact, the first couple of months I felt so wonderful! It was as though my heart was lightened, the abyss was gone.
My life revolves around creativity. It's my job, and everything else too. To lose that would have been devastating.
I take Celexa, only 20 mgs.
Sorry, there is much more to be said, but I can't write anymore right now.
I am sorry you fear snickering. I can't imagine your T doing that, especially if he is connected enough to realize you might need some help he can't provide. Doesn't that show a certain degree of compassion and caring?
ShortE
Posted by Racer on August 25, 2004, at 0:04:22
In reply to Psych eval woes -- any insight?, posted by Aphrodite on August 24, 2004, at 21:12:03
Whaddaya know? I'm hardly out of my own crisis, but here's something I can actually answer -- because I just did the initial thing with a new, private psychiatrist today.
First off, I'm with Dinah all the way: the meds can help provide enough relief that therapy can be much more effective. Now, I'm not typical -- I probably score 25 out of a possible 10 on the "depression predict-o-matic", but the first time I took an antidepressant it was almost like a miracle. We'd been bogged down in therapy for a long time, after a lot of good work, but we were at a point where it was just plain too painful, too impossibly painful to get any further. My therapist was actually against medications -- which eventually led to me ending therapy with her, but that was much later -- but my GP "strongly recommended" that I see a pdoc and go on an AD. I did, and it helped. No, people didn't suddenly start breaking into song in the streets, but it did allow us to get past the roadblock to some of the most painful portions of my past -- and to work through those issues effectively enough that none of those old maladaptive coping strategies has come up until this recent nightmare. Let's see, that's about six months on Nortryptiline about 20 years ago? Yep -- even worth the weight it put on me.
The best news about ADs, by the way, is that there a many more now, and many are much easier to take than the old ones. Yeah, I'd rather not have to take anything, but if it provides you with a tool to help you make the therapy work for you, and it helps keep you from the sort of agony that intense therapy can bring on -- for a first episode of Major Depression, most authorities say stay on the med for anywhere from nine months to two years, and you can probably stop it and never need it again. Scary, yes -- maybe worth it. (And I'm one of those goofy 'won't take aspirin for headache' types who really hates taking any medication for anything. Last thing I am is a med happy drug pusher. But, sometimes it can help, and it doesn't have to be forever.)
As for the eval.
Would it surprise you to learn that sometimes I talk too much? We went about two and a half hours instead of his official one and a half hour initial eval. During that time, he asked for family and medical history, asked about some specific symptoms, and mostly heard me out. Yeah, he asked a few questions that scared me -- things that sounded like "QuickFixDiagnosis" warnings, but when they came up I told him that I thought they were byproducts, not diagnoses, and we talked about it a little and he *said* he agreed.
Now, you might not be surprised to hear that I was scared to death -- almost literally -- about this appointment. Honestly -- I very nearly called to cancel the appointment WHILE I was driving there. First thing I told him was that I'd been in a nightmare for almost a year, and that I was almost too scared to be there. (Of course, now, hours later, I'm kicking myself for saying so, since 'gee, I must look nuts...' etc) Having that on the table up front helped me.
Several people I know, respect, admire, and trust have told me that they much prefer their DOs to any MD they've ever seen.
And, remember a couple of Helpful Hints: you can always say no. Just because s/he wants to prescribe it, don't mean you gots to take it. And ask up front about drug trial philosophy: how long does this doc have you take something before deciding to switch/change dose/stand on your head? What criteria does this doctor have for response? What lab tests will this doctor have done? (Do get your thyroid checked -- everyone says it, it's worth asking for just in case.)
And my own, personal advice to you, on accounta I like you: Always remember, it's harder to get into Veterinary School than Medical School...
(Racer's Reaction to Certain Stressors: I get way over-chatty. Like no one noticed. At least this was one where maybe my chatty can be helpful -- I hope so, at least.)
Posted by vwoolf on August 25, 2004, at 4:14:31
In reply to Whoohoo! I get to give back now! (long -- !! ) » Aphrodite, posted by Racer on August 25, 2004, at 0:04:22
Hey Racer, you're back? Great.
Posted by Dinah on August 25, 2004, at 9:11:29
In reply to Whoohoo! I get to give back now! (long -- !! ) » Aphrodite, posted by Racer on August 25, 2004, at 0:04:22
I'm glad you have a hopeful experience there, Racer. You're overdue for one.
Do you feel like this doc will be a good match?
Posted by Racer on August 25, 2004, at 12:25:03
In reply to Re: Whoohoo! I get to give back now! (long -- !! ), posted by Dinah on August 25, 2004, at 9:11:29
> I'm glad you have a hopeful experience there, Racer. You're overdue for one.
>
> Do you feel like this doc will be a good match?
LoL! That made me laugh, for some reason. I guess because I do feel so much that I'm *wrong* about everything (big topic in therapy this morning), that I second guess myself and talk myself onto both sides of every issue.I think the easiest answer is, "The jury is still out on that one..."
The real answer? I think I'm so frightened by what's gone on, that it's like an allergy now: I've been sensitized to the allergen (pdocs), so my psychological immune system over reacts to small doses. That's certainly a lot of what I think is going on right now, but -- big one -- I did not sleep at all last night, much too agitated, and I get so speedy when that happens that I don't trust my opinions all that well? Over all, though, I think there are enough positives -- even if this guy *ain't* the Big Magoo for me -- that it probably outweighs everything short of outright physical abuse on his part, you know? I made it to the appointment -- honestly, I *think* that alone is positive enough almost to justify the expense. And, my husband is getting the prescription tonight after work, so I'll start a new drug tomorrow -- if the first wasn't enough, the fact that I'm even willing to try anything without literally having to have it pushed down my throat probably pushes it over the top.
Dinah, I think I'm still much too anxious/agitated/frightened/crazy to be able to say that, yes, I do think this guy is probably a better fit. I'm not sure if that would be true, and am trying to work it out, but I'm certain so far that we can call him Dr Maybe for a while, if not Dr It.
(OK, I need a good game -- what shall we call this guy? *Very* academic professional background, lots of university and inpatient stuff on his CV, advanced degrees and experience in ECT, doesn't believe in hospitalizing patients much -- says it gets to be too easy for some doctors, and I think I agree in principle, although I suspect there's more to that story -- *says* (<< suspicious? Moi?) he believes in general scientific principles that I believe in like not adding three new meds at once, seems like a nice likeable guy -- made me laugh a bit by saying something about "Prozac -- the Great Anti-Obesity Drug from the pre-marketing studies. Yeah, and it is -- for the first two months, after that it turns around." At least he really seems to *get* that part as an issue -- and he did say that he attempts to deal with it. What are we gonna call him?)
(And yes -- I did come a little close to calling Dr EyeCandy by that name in the eval. Just close enough to make me slightly tense... Do you ever think about how Bubba would feel to learn his name? In my current, sleep deprived idiocy, I'm getting a certain malicious glee from my guess at how Dr EyeCandy would react to being called that.)
Posted by Dinah on August 25, 2004, at 14:11:21
In reply to Dontcha ever learn? » Dinah, posted by Racer on August 25, 2004, at 12:25:03
After one of my favorite Weird Al songs. My husband and I were going to dance to it at our wedding but was afraid others might not share our sense of humor.
You never know. I had a transition pdoc after my disastrous one, but sometimes the transition guy turns out to be a keeper. :)
I hope you feel better soon. I know that agitated lack of sleep feeling, and hope you get a few good nights sleep soon.
Posted by Aphrodite on August 25, 2004, at 14:45:41
In reply to Re: Psych eval woes -- any insight? » Aphrodite, posted by Dinah on August 24, 2004, at 21:45:55
Thank you for the insight, Dinah. I kind of imagined it would be a little "colder" than the sessions with my psychologist, and I'm just fine with that. One complicated relationship is enough.
I'm deliberately not going to the pdoc he recommended b/c I am trying to cut down on the potential of them discussing me. You'd think I'd want them to so I could have a team working on this, but I'm just not comfortable with that at all. I guess I am also intellectually curious what a true second opinion will be like. In the first visit, do they usually give you a diagnosis?
Posted by Aphrodite on August 25, 2004, at 14:49:03
In reply to Whoohoo! I get to give back now! (long -- !! ) » Aphrodite, posted by Racer on August 25, 2004, at 0:04:22
I'm so glad you're back and feeling chatty! It was very helpful to me. Your questions about meds and follow-ups are good ones to remember. I would not have thought to ask that.
I do worry about getting any easy diagnosis, so I won't let the job be that easy;) I hate it when people try to force me into a category or type.
Hope things are on an uphill swing for you.
Posted by Dinah on August 25, 2004, at 15:51:20
In reply to Re: Psych eval woes -- any insight? » Dinah, posted by Aphrodite on August 25, 2004, at 14:45:41
If something's pretty clear they'll probably give you a diagnosis of that. If something is possible, they'll say "rule out xxxx". I got the notes from one, and he gave a diagnosis of major depression and OCD and a rule out diagnosis of borderline and schizotypal. What he had in the notes was pretty much what he had said when we met, so it was no big deal.
I have to agree with you about the conferring. I know it's worked well for many, but it was such a disaster for me that I don't think I *ever* want a pdoc that is in regular contact with my therapist again.
And I did get a completely fresh start with the pdoc I have now. No consulting with my therapist, no transfer of records. And he noticed things about my meds that I wonder if he would have noticed if he hadn't come in with no preconceptions. And he had a completely different diagnostic impression on the Axis II personality disorders. Came as close as a doctor can come to saying that the previous doctor was completely wrong.
It sounds as if you have a good plan in place. Good luck!
Posted by DaisyM on August 25, 2004, at 18:57:14
In reply to Psych eval woes -- any insight?, posted by Aphrodite on August 24, 2004, at 21:12:03
>>> I got shocked into reality when he asked me to go to a pdoc.
I know this feeling...we so quickly go to the place that says, "I knew it! I AM too much for him!" I had the same reaction when mine suggested finding more support and medication for sleeping. I think you have to think of him as your team leader...organizing anyone who might help you but remaining in charge of your treatment. Different strengths, you know?
I've always been impressed that you talked about your past, however briefly, on intake with your therapist. It took me months to even hint that something had happened to me. Since you were able to do this with your therapist, it seems logical that you can do it even more broadly with a pdoc. They must respect your confidentiality.
I think exploring extra help (medications) is a good idea. You don't have to be completely sold on the idea but you've been pretty down and this might help. I'll be interested to know how it goes.
Daisy
Posted by Racer on August 25, 2004, at 20:52:05
In reply to Re: Whoohoo! I get to give back now! (long -- !! » Racer, posted by Aphrodite on August 25, 2004, at 14:49:03
Repeat as needed: Racer hasn't been sleeping. Racer didn't sleep at all last night. Racer gets really, really speedy without sleep. Racer talks too much *with* adequate sleep and virtually any topic...
Then, repeat again -- I hope you understand that I'm really pretty incoherent to myself right now.
Anyway:
1. You and Dinah hit on something that I waffle about a lot: pdoc/therapist? NO pdoc/therapist? My recent experiences are the first with a very close pdoc/therapist thing. 'nuf sed. Then again, probably the most overall-beneficial experience I've had to date was with really, really close pdoc/MD coordination -- and I would like a little pdoc/therapist communication, because I have had experiences where I *needed* meds or a med change *NOW* and the therapist could probably have gotten a much better response than I'd have been able on my own. Too depressed to make sense, bad med reaction that I couldn't see, and the old standby -- feeling as if I *deserve* to feel this bad because {duh} I'm depressed. I swing both ways on that issue, but lean towards some coordination ability -- but not lunch buddies, you know?
(The pdoc/MD thing? Don't ask/don't tell -- I think they were probably ex-lovers, I could tell by the beautiful way they worked together to treat me that they loved one another. Personally, I think it helped in that treatment. Who knows? Long ago -- and they were both women of a certain age, with that common ground of struggle in very male areas. That alone might have explained it all -- Women Helping Women was enormously important to them both.)
2. Forwarned is forarmed: *knowing* about the dangers of that easy diagnosis will probably go a long way towards helping you spot it.
(Got maple syrup?)
Then again, if it works, what does it really matter what they call it?
(OK, sit down and grab that fork, butter me, and get ready for more waffling..)
Always keeping in mind my other thought which might be much, much stonger: "If it doesn't matter what it's called, as long as it's being treated effectively, NEVER EVER EVER trust any medical professional of any sort who places seemingly undue importance on the diagnostic name." Yeah, I'm incredibly sensitive about that whole issue right now. But you know what? The DSM diagnostic codes really seem to me to have two important jobs: one is insurance -- what's the doctor gonna tell the bean counters to get them to help pay off his/her med school loans? The other is contained in the title of the book: "STATISTICAL" How do you quantify these things? OK, why don't we put together a consensus and call it -- Diagnostical and Statistical Manual for Mental Disorders or something like that? (Thank you, required stats class!(
3. What Daisy said brought something a lot more amorphous to me re you -- but let's let it percolate a little, and maybe stir in a buncha hours in LumLand? It "feels" too important not to make as coherent as possible for you?
So, Ms LongHair And Pearls Painting, I hope it really was helpful -- that you're not being kind -- and really hope that you find you experience something like what I did way back.
By the way, a very wise woman said something today that totally rocked my world off its axis. You know I keep trying to explain what those first meds did in therapy? One sentence I'd never been able to find, she said so beautifully and I'm sure to mangle it, but basically: "The medications allowed me to move from *feeling* the old pain to *grieving* for it." Continuing to feel the pain is what causes the problems (if you can get it in your area, the PBS show Medical Answers often gets totally off the wall gems -- like a show about the anatomy of pain and why it *needs* to be taken more seriously by doctors and treated aggressively, whether mental or physical -- trust me, that show was related to this point) but grieving over that pain, over having had to go through it, over what actually happened, whatever your loss -- grieving it is a huge step in the direction of healing.
I hope that being able to see it that way makes it eaiser for you -- IF the pdoc wants to try a med. Could say, "Naw? Medicate for that? That looks like my idea of a normal reaction -- and I prescribe the following schedule of vacations from work and facials at the salon -- insurance will cover it if I prescribe the time off." Dr Racer'sDream, by the way, *will* be the one who looks at a lot of those "life" issues instead of at which drug company provided the best lunch this week or what the last three patients all responded so well to.
Be well
Posted by gardenergirl on August 26, 2004, at 8:57:29
In reply to Re: Psych eval woes -- any insight? » Dinah, posted by Aphrodite on August 25, 2004, at 14:45:41
> > I'm deliberately not going to the pdoc he recommended b/c I am trying to cut down on the potential of them discussing me. You'd think I'd want them to so I could have a team working on this, but I'm just not comfortable with that at all. I guess I am also intellectually curious what a true second opinion will be like.
Actually, if you don't give permission for them to confer, in writing, they would be violating HIPAA laws if they did. Same holds for whomever you end up seeing.
Interesting, my new pdoc showed absolutely no interest in conferring with my T. You would think that someone who has known me for a year would be able to provide valuable outside observations about my symptom presentation, but I guess she does not feel she needs that.
Good luck!
gg
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