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aquarian

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Everything posted by aquarian

  1. I apologize if the OP or anyone else was confused by my post which was about my experience with my psychiatrist. When I said "the usual" I meant to convey that I'm used to a certain length of appointment. She schedules me into 20 minute time slots which sometimes run over and for me, 5 minutes would not be enough. She usually codes my visits as 99213 EM OV L3 or 99214 EM OV L4 which is more expensive for me. Though during a tough time I got billed several times under L5, the most expensive. I always was under the vague assumption that the L4 & L5 visits cost more because it seemed those were the appointments where we would run over my time significantly, plus she had to do more thinking that just writing the same old scripts (emphasis on "vague assumption" as I shouldn't assume). But I never timed my appointments or asked her why some were more expensive. When totally stable (many years ago), I always got billed under 90862 Med Management which was the cheapest. When I looked online to find out more about the E/M coding of my visits, it got interesting. One source said "Evaluation and Management (E/M) codes are selected through one of two pathways: 1. Based on the elements (history, exam, or Medical Decision Making) 2. Based on time (when counseling is provided for more than 50% of the time spent face-to-face with the patient)" http://www.thenationalcouncil.org/wp-content/uploads/2013/06/NC-CPT-FAQ-for-2013-V3.pdf Also here says about the same: "Potential coding options for providing follow-up for a depressed patient would include 99212, 99213, 99214, and 99215 for medical management (the level determined by the complexity of the diagnoses and medical decision making [MDM]) or for counseling (the level determined by the time of the encounter). The 3 key components of documentation for medical management are history, examination, and MDM. For initial visits, all 3 components must be documented according to the specific requirements of the code; for follow-up medical management visits, 2 of the 3 components must meet the necessary level of complexity to support the chosen code level. For follow-up visits, time is the controlling factor when counseling dominates > 50% of the visit." http://www.ncbi.nlm.nih.gov/pmc/articles/PMC427609/ I'm not sure what counts as "counseling," so I googled that: "Counseling is defined as a discussion with the patient and/or family concerning one or more of the following: diagnostic results, prognosis, risks and benefits of treatment, instructions for management, compliance issues, risk factor reduction, patient and family education." (see page 10 of pdf download linked to below) One example where time could be used as a factor in choosing an E/M code: "A patient returns to a psychiatrist’s office for a medication check. The encounter takes a total of 25 minutes, during which time more than 12.5 minutes is spent explaining to the patient about how a newly prescribed medication works, how to establish a routine so that no doses will be missed, and the possible side-effects of the medication and what to do if they occur. The appropriate E/M code would be 99214 (office or outpatient service for an established patient), based on the 25-minute time rather than on a detailed history and examination and moderately complex medical decision making that would be required to use this code if counseling and coordination had not taken up more than 50 percent of the time." http://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Practice-Management/Coding-Reimbursement-Medicare-Medicaid/Coding-Reimbursement/CPT-Coding-Psychiatric-Care-Background-Material-2014.pdf But yes, the best thing to do would be to ask the scheduler or doctor (if they do their own scheduling) how long the appointment is set for.
  2. When I was a teenager I was forced to see a pdoc briefly and he was the 5 minute type. I've been seeing my current pdoc for over a decade now and she's awesome, but not taking new patients so I'm thankful I got in with her when she was relatively new. I mentioned my old pdoc to her once (because I think he was listed as the head of the IOP program I briefly attended) and she just laughed and said, "oh, he's a 5 minute psychiatrist." I would be a little angry if my psychiatrist cut my appointments off after 5 minutes instead of the usual 20 minutes because I pay for a 20 minute appointment. However, I don't think I've ever asked my psychiatrist an "emotional question" (although I'm not entirely sure what the OP meant by that). But it does take about 20 minutes to catch her up on symptoms/side effects/life changes/etc. and then discuss what scripts I need refills on. I suppose we could cut it back to 10 minutes if we skipped the life updates but often the updates on my life are intertwined w/symptoms & side effects and thus relevant IMO.
  3. I assumed saintalto was referring to the person posting on the schizophrenia board who stated "More recently (I'm 13 now) I have begun to see...", but that's just my assumption.
  4. The study cited above advises in the conclusion: "Due to limited studies, especially dose-response analysis, and potential reverse causation, these findings should be treated with caution. Large prospective cohort studies with long follow-up duration are needed to confirm whether the association between long-term benzodiazepine use and increased risk of dementia is causal." http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0127836#sec025 And, if it makes you feel any better, there was a BMJ study that found "The association with Alzheimer’s disease was stronger for long acting benzodiazepines (1.70, 1.46 to 1.98) than for short acting ones (1.43, 1.27 to 1.61)." http://www.bmj.com/content/349/bmj.g5205 And in that study at least, "the use of benzodiazepines could be just a signal that people are trying to cope with anxiety and sleep disruption—two common symptoms of early Alzheimer’s disease. If that’s true, their use of a benzodiazepine may not be a factor in causing dementia but an indication it is already in progress." http://www.health.harvard.edu/blog/benzodiazepine-use-may-raise-risk-alzheimers-disease-201409107397 In my case, my psychiatrist thought it best I transition off of xanax after maybe 1-3 years or so (I have a terrible memory) and go onto valium instead. I made the switch probably around 2004.
  5. Interesting site. I looked up my pdoc and she received a few hundred dollars in meals a few years back according to it. Not enough IMO to influence the number of prescriptions she writes every day. From what I have seen over the years, my pdoc treats the pharma reps rather like a irritation, a nuisance she puts up with in order to get tons of free drug samples. For awhile the drug reps would stalk her in the waiting room and try to catch her between patients. Later she put up a sign saying they have to have an appointment with her. I also remember hearing her turn down an offer to come to an informative dinner one of the companies was holding where speakers talk about new drugs and an offer to sit in on conference calls. She didn't sound exactly thrilled at the prospect of wasting her time attending these types of events. ETA: I went to the other site https://projects.propublica.org/docdollars/ and my pdoc received $700+ from Aug. 2013 to Dec. 2014 from various companies, mainly for "food & beverage". While good to know and interesting to see which drugs/companies the money came from, I still think this isn't very much money in the grand scheme of things. And if I ever felt like she was prescribing me newer drugs (those still under patent) just to benefit drug companies, I would change pdocs. I guess it would be trickier if the patient wasn't able to change pdocs for various reasons.
  6. Have you ever read Quiet: The Power of Introverts in a World That Can't Stop Talking? It's an enjoyable little read. To the original poster, I'm an introvert and I also have a tendency to isolate, which for me is a bad thing (to the extent I take it). And isolating has it's own inertia, so I agree with jt about just watching to make sure the isolating trend doesn't continue.
  7. I'm a fan of poems but have been very lazy about reading them the past few years. Perhaps I'm avoiding them. I have a book by Joanie Mackowski that I’ve enjoyed somewhat recently and I consider it somewhat life-affirming in its own way. (However, poetry can be rather personal like taste in music.) Here’s the first lines of the first poem in the book: The whole poem can be read here: http://www.kenyonreview.org/journal/fall-2006/selections/joanie-mackowski/ Here’s a link to another poem of hers, Consciousness: http://www.poetryfoundation.org/poetrymagazine/poem/243358 The first lines: I’ve gotten quite a bit of use out of Ellen Bryant Voigt’s The Cusp over the years. I reflect on it during certain times in my life. It’s a bit sad but also hopeful (in my opinion). She's not normally a favorite of mine but I've always connected to that poem. That’s all I can come up with off the top of my head. I would be interested in your list(s) if you want to share.
  8. I have not experienced that. I've been on 300mg since around 2002 (with a very brief switch to Pristiq a few years back but then I went back to effexor). Of course, YMMV. Also, I've been taking generic effexor since whenever it became generic in the US, in case that matters.)
  9. Haven't taken ativan but for me, putting valium or xanax under the tongue instead of swallowing makes it kick in a lot faster. Xanax (generic) truly is the worst tasting thing I have ever experienced but I was willing to take it under the tongue in emergencies when the panic attack was really bad and/or if I had no water around. Valium (generic) is pretty bland and just chalky, for me at least.
  10. I did a sleep study and I don't remember having to wear a mask. I think I had to wear something under my nostrils and had lots of sensors hooked up to my head and body, but no mask. They didn't find any problems with sleep apnea in my case, but if they had, I think then I would've been fitted for a mask.
  11. My psychiatrist will take unused medications from me (that she's prescribed) if they are in sealed blister packs or if the pharmacy gave them to me in the sealed original manufacturer's bottles where you have to peel off the tinfoil seal thing after removing the cap to get to the pills (assuming I haven't opened the bottle and peeled off the seal). If they are unsealed or in regular pharmacy bottles, I usually mix them with really gross trash and throw them out. I think technically things like oxycontin, morphine, etc. are recommended by the FDA to be flushed because they are so at risk of being used illegally and possibly causing death, but it's a short list of flushables.
  12. You already seem on top of the networking thing (I never was any good at that). Good to know the outpatient program has been of some use so far. I never completed the outpatient program I went to briefly due to not being able to drag myself out of bed and the house on a daily basis at the time. Plus, the groups were draining (being around other people, especially ones also going through tough times, sucks out my life force). So I'm always impressed when other people can complete things. I kind of wish I could have another try at the IOP thing now that I'm on adderall but I'm also on medicaid at this point, which is nice in some ways but limiting in others. Your boss sounds impossible and I kind of agree with CeruleanBlue that she may always keep you on pins and needles, no matter what you try with her. I should've probably mentioned in a prior post that I was a very tiny peg in a very large company that happens to provide group disability insurance. So my managers and supervisors and everyone were all very familiar with FMLA/STD/LTD etc. E.g. My manager was previously an LTD unit leader in the same company. But they were all nice, smart, supportive people in general and were all about helping us succeed. Sorry your manager isn't like that. I can only guess that she has her own insecurities or issues.
  13. I'm glad your FMLA was approved and the STD process has been started. I'm sorry that your work environment is such that people might hold your time off against you. I do not have any experience with that as where I worked everyone was supportive or at least neutral. If you're not ready to go back by December 1st, than perhaps you can extend your leave. However, I found that the longer I stayed away, the harder it was to return each time and get back into the groove. Some other things I did (with my pdoc) to ease me back into work was to start back later in the week (like a Thursday or Friday) so that I would have the weekend to give me a break. Also, one time we tried doing half days returning to work. Another time we did a 2 hr day, than a 4 hour day, than 6 hrs, and so forth. That actually worked out pretty well because there wasn't usually much for me to do the first few days back because it'd take awhile to get all of my log in credentials working again. But definitely try to set yourself up for success, so if you think you need a week of half days to ease back in, than have your doctor approve you for that. My experience was that they (company and STD provider) both just wanted me to go back to work and didn't really care how the return was structured as long as it was reasonable and I had my doctor's support. At my company, the FMLA ran concurrent with STD so the longer I was out on STD (very common), the more FMLA I was using up. Eventually I used up all of my FMLA for the year and was slightly paranoid that my company would dump me. I'm not sure how that would have worked, but somewhere along the way I got the impression that it's a pretty rare thing for a larger, "nicer" company to bother with. Mostly they just let you stay on the rolls and continue on disability, always with the potential to return to work (although I did get a letter way, way into the process that they were going to post an opening for my job role). Also, from prior posts, I remember reading that you were a pretty productive employee and a lot of times a company would rather keep a productive employee that's already been vetted, trained, and that they know is a solid employee and part of the company rather than hire someone new. This is not always true, but where I worked it was true. I live in an at-will state, by the way. And FWIW, I still have a hard time using my cell phone alarm to wake up because it was my initial alarm back when I used to work (one of several alarms I used to ensure I'd wake up). It still sometimes makes me panic for a split second to hear it or gives me a feeling of dread. It just dredges up tons of memories for me. So I tend to use my digital alarm clock instead.
  14. Glad to hear HR got back in contact with you. I had no issues with the company I used to work for when I used FMLA & went on STD and finally LTD, although I did get really anxious (probably for no reason) during the times when I hadn't yet been officially approved for additional time off that I was taking. It always worked out in the end because my pdoc was really good at filling out paperwork. (There's generally more paperwork required for STD than FMLA.) STD was also good about working with me to return to work on a part-time basis before transitioning back to full-time. I ended up on LTD in the end, but it was just me not being able to handle a full-time, stressful job at that point in my life. Good luck with the outpatient program. Hope it helps.
  15. As far as FMLA goes, even if your intermittent or continuous "chunk of time" hadn't yet been approved, I believe that because you went straight inpatient into the hospital after consulting with your doctor, it's an emergency thing and "unforeseeable"--like if your appendix burst. After taking leave for something "unforeseeable", according to FMLA, you have to notify your employer "as soon as possible and practical" (which you did). See: https://www.dol.gov/whd/regs/compliance/whdfs28e.pdf It's also normal to get an extended deadline for paperwork that is insufficient, illegible, etc. And you may have been granted even further time due to needing to get an appointment with your doctor first and your having jury duty (good faith efforts). For example: Q. What happens if my employer says my medical certification is incomplete? A. An employer must advise the employee if it finds the certification is incomplete and allow the employee a reasonable opportunity to cure the deficiency. The regulations require that the employer state in writing what additional information is necessary to make the certification complete and sufficient. The regulations also require that the employer allow the employee at least seven calendar days to cure the deficiency, unless seven days is not practicable under the particular circumstances despite the employee’s diligent good faith efforts. http://www.dol.gov/whd/fmla/finalrule/NonMilitaryFAQs.htm In fact, if it were me making the determination on your FMLA claim/leave, I would treat this new inpatient leave as an entirely new and separate FMLA claim from your previous intermittent claim/leave that was possibly going to become a continuous (foreseeable) claim/leave and start the 7-day (or whatever) clock the day you were admitted inpatient to provide a brand new medical certification from your doctor. But of course I'm not making the determinations. I also couldn't tell exactly what your question was. Are you worried about losing your job because of not getting your FMLA certification in on time or worried because you asked HR about making a formal complaint about your boss? So far it seems HR has been accommodating to you. And your boss's behavior and remarks are completely inappropriate and it sounds like HR needs to have a more serious talk with her.
  16. Supposedly exercising is supposed to give you more energy. More often than not though, I'm too tired or not motivated enough to exercise. Not enough Vitamin D or iron will make me even more tired so be sure to have your levels checked. I take adderall and so far it's the only thing (aside from iron and Vitamin D) that's helped to reduce the amount I sleep. I usually only sleep 10-12 hours per day now which is an improvement. It also helps me be more alert and able to focus on tasks for the first part of the day and not want to constantly crawl back into bed. But if I take a second dose, it makes it difficult for me to fall asleep. I had to do a sleep study, brain mri, and see an endocrinologist first. Everything came out normal (aside from extremely low iron and Vitamin D). Then my psychiatrist had me try nuvigil, then ritalin, then finally adderall worked. It helps me with my mood too. I still get exhausted doing anything outside of the house though, but I can get more done than I used to. There are many kinds of tired though, from many different origins.
  17. aquarian

    smoothie diet

    fwiw, i tend to get grittier smoothies when i use (frozen) berries in general, though strawberries are usually fine. the apple skin could of also maybe done it if you left the skin on (the skin is a great source of insoluble fiber though). costco i think has/had a triple berry frozen fruit package (blue/black/raspberries) and whenever i would use even a little of it, i would get grittiness. i also like to add non-dairy milk with the fruit like soy or almond milk. bananas also help with consistency/texture but are super sugary. and my mom's vitamix gives a more consistent blend than my ninja master, though the ninja master works well enough for the price.
  18. I've periodically had to attend services at a few Christian churches and a Unitarian church. (I'm agnostic/almost atheist.) While I liked taking religion classes in college, I find most church services insanely boring, especially because I don't sing and don't enjoy singing and there always seems to be singing involved. Also, I always feel very awkward during certain portions of most religious services. Like with the crackers and grape juice being the body and blood of Christ. I never know if I should take and eat the stuff or not since I don't believe. Also, the bowing your head to pray thing. I don't pray so it gets old after awhile contemplating my navel and making up to-do lists in my mind. And if there's a responsive reading, I often can't participate in it if it references things that are too religious that I don't believe in. I felt least uncomfortable in our local Unitarian church, but probably because it's so non-religious (there were complaints from the congregation at one point that the pastor guy was using the word "god" too often). But at least I could participate in responsive readings for the most part and there was no blood of Christ. So the thought of attending a Christian church for the community aspect would never even occur to me because just so much of the service doesn't apply to me. If I liked to sing in the church choir, I could see joining for that aspect. If I wanted to be a part of a community, I would join a hiking club. Or volunteer at an animal shelter. Or volunteer through the Unitarian church or some other organization. Etc. Etc. But that's me. If someone asked me to attend a church service I wasn't interested in attending, I would probably just say, "no thanks" or "I'm not really interested in attending any religious services at this time" or "that's my day of rest." Because saying I go to another church may not put them off (they might want me to still visit the snake-handling one anyways). It's polite to say you'll "consider it," but eventually she may want a definite yes or no.
  19. found the thread with your post in it: http://www.crazyboards.org/forums/index.php?/topic/78310-just-out-of-curiosity/
  20. I disagree with this^^. A person can not always get all their nutrients in 1200 calories. Say the person eats candy all day to equal 1200 calories. That isn't getting them all the nutrients they need. I found the best results when I really cut back on the junk food. I wasn't having the crazy sugar rushes and crashes, and I didn't feel the need to over-eat to combat the crash, which made not over-eating a lot easier. I've found the same thing when it come to cutting back on junk food and having less blood sugar crashes. Also, my psychiatrist and I spoke about my weight gain at my last appointment (I've gained over 100 pounds in the past few years and had never been overweight previously, thyroid & pituitary normal, etc.). She told me that I probably only need to eat about 1000 calories a day on days when I stay inside and just watch tv, go online, and knit (which is most days). That was just my doctor's advice to me though for completely sedentary days. Good luck Melina. I'm also struggling and uncomfortable with/in my overweight body, but at the point right now where I'm not quite motivated enough to try.
  21. There was a similar thread about this last month: http://www.crazyboards.org/forums/index.php?/topic/77424-when-are-cbd-ap-coming-to-save-us/
  22. I switched from xanax to valium over a decade ago although I still have xanax for emergency situations. I remember a lot of sweating and feeling very uncomfortable. It was a miserable time, but things eventually smoothed out. I remember the switch being more physically brutal than quitting smoking (although quitting smoking was probably tougher mentally, even now I still miss smoking). Were you dependent on Xanax when you switched to Clonazepam? I can imagine there would be little to no issues switching Benzodiazepines if there are no issues with dependency before the switch. However I'm wondering if there is any withdrawal symptoms or other affects (considering the change in the duration of acting life) if you are dependent on the Benzo you are trying to replace? If you are not ready for therapy you have every right to decline it. I can understand why it feels like she is forcing you into therapy, and why it feels wrong. However, I just wanted to point out that therapy is a lot more than just "talking out feelings". Certain therapies, especially Cognitive and Dialectical Behavior Therapy for anxiety disorders, are designed to teach you how to form skills and techniques so you can control your anxiety, and in the long run help your medications work better and you may even need less medications. Medications are not magic bullets, especially with anxiety. It took me years to learn that and in the meantime I suffered. It's a balance of skills from therapy, and lifestyle, and medications. I was in your spot, so please don't think I'm trying to lecture. Counseling therapies and "talk" therapy can help for certain people and certain types of MI. But for anxiety disorders, a more active approach and skill building therapies are much more helpful than "talk" therapy settings, and are very worth a active try. I very much so wish I could decline. It's not optional at this point. I either have to go, or get no meds. The last time I seen my therapist was when they tried to "sneak therapy"(as I call it) me. My pdoc wasn't there one day, but they didn't tell me that until my tdoc had me back in her office. It consisted of about 10 minutes of me staring at the wall and giving only "yes" or "no" answers. I was beyond non-compliant. I just really don't feel like I'm getting anything out of it. We sit there and talk for an hour. She gives me no skills, no new approaches to things, just nothing. I wish I had the kind of therapy your talking about. I have two weeks to prepare myself for the inevitable. I hope you can connect up with a therapist that better meets your needs.
  23. Coming out of lurkdom to post an article where I read about this: http://www.health.harvard.edu/blog/benzodiazepine-use-may-raise-risk-alzheimers-disease-201409107397. Article has a link to the study published in the BMJ. The study dealt with people over age 66. Those on longer acting benzos were more at-risk than those on shorter acting benzos like xanax. Also, the study did not prove causation (i.e. that benzo use caused Alzheimer's) and states this clearly in the "Strengths and limitations" section. It could be that those in the early stages of Alzheimer's or dementia often have anxiety and sleep disorders that are treated with benzos. There may be other studies, but I had this one bookmarked because I've taken xanax and valium over the years.
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