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So-- some of you will have read my past posts about being freaked out about going to a pdoc for the first time and having to pay $200 for it since my insurance doesn't cover it and my high hopes that he would be someone who *listens* not just a pill-pusher. Ah, well. A girl can dream, can't she?

Appointment did not go so hot, question:

  • why do they make you fill out 6 pages of "check this box if you've felt this way in the past this many weeks/months/years" and "check this box if you feel like killing yourself" and "check this box if you've been through something more tramatic that seeing dr.--- for a pdoc" and "check this if your hair is blue" and "check this if your hand is cramping" if they DON'T EVEN READ IT?

Another question:

  • if you are a pdoc for a living, can't you get someone to diagnose YOU as ADHD? for god's sake, at least let me finish a sentance or stay on one topic long enough for me to nod yes or no! I wanted to hand the new Focalin script right back to him, say "here honey, you need this more than I do," pat him on his overly-gelled head and walk out.

He's letting me go off of the zoloft (thank GOODNESS) after 6 months of it just making me tired and doing nothing that I know of--he told me to go from my 100mg down to 50mg for two weeks then stop. I'm happy with that choice, we saw eye-to-eye on that one at least. He's not touching my Wellbutrin 450mg even though I told him it stops working after about a month usually and that was my big concern ("we'll deal with that...worry...let me..um" which I took to mean "we'll worry about that when we come to it and you pay me more $$ for a few more appointments") and added a script for 10-20mg of Focalin (one of the isomers in Ritalin) and therefore a Dx of ADHD inattentive. It makes me sleep. Like sleeping beauty but with bad hair and snoring. He charges $25 for every 6 minutes you spend on the phone with him so I can't call him and ask why on earth a stimulant would conk me out like a club over the head.

One last question (a real one this time, I promise!):

  • Any clue where I should go from here?

Even if you have no advice, anybody have any pdoc rants to share? lol.

I'm so so sorry for babbling on like this and I hope that some of you are patient enough to read or skim through it all!

Thanks,

meg

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It makes sense to make only one med change at a time. I suspect next month he would be willing to adress your other med.

Thanks AM,

I know it wouldn't make sense to change everything all at once but I was hoping that he would at least think about what we'd do in the future or tell me why he chose a stimulant to add to my wellbutrin even though I obviously don't have adhd and we didn't discuss any other options or anti-depressants or anything. The only reason that he gave me for the focalin was that he had a free coupon for me to use and that he prescribes it a lot for everyone from "liiitle liiiitle kiddos" to "people in their 60s still working who are fine but need more pep at their jobs."

I don't know. You're right that I shouldn't have expected a big change all at once tho. hmm.

so just keep taking what he prescribed and wait?

oh so sensible ;)

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hi meg, i'd love to be able to write and make sense like you do, (am unable when a cycle..) keep writing posts, easy to read xx by the way i'm 23 and still pushing for thorough assess/dx, hope yet for me then! lol, if you ever wanna chat.. ..sal x

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$25 for 6 minutes of a phone cal??? That's ABSURD. One should be able to call doc and ask a questions without paying. Greedy bastard.

And the guy said he prescribes it to people who need more pep? Where is this guy and can I go? My pdoc laughed at me when I asked for a stim because of my history with abusing meds. Your doc sounds sketchy. And yes, a little crazy. But maybe he is a good doc, hang in there and see how it goes. TIll then feel free to rant on! I love me a good rant.

I see the benefits of changing 1 med at a time even though it will probably take longer. That way you know what med is doing what. My doc does multiple changes at once so if I see a change, positive or negative, I don't know what med did it. It's all a frickin' crapshoot. A test of trial and error. Really annoying.

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And the guy said he prescribes it to people who need more pep? Where is this guy and can I go? My pdoc laughed at me when I asked for a stim because of my history with abusing meds. Your doc sounds sketchy. And yes, a little crazy. But maybe he is a good doc, hang in there and see how it goes. TIll then feel free to rant on! I love me a good rant.

yep- he's an abuser/college student's dream, lol-- I bet I could go in there and get all the adderall, ritalin, whatever, I just have to look and see what posters he has around his office to see what I could get for free

DR- have you ever been on adderall or ritalin?

me- no, never had a--

DR- nobody prescribed it for you when you were little? adderall?

me- no, I don't--

DR- adderall, ritalin, focalin, yeah, focalin, ever heard of focalin?

me- ye--

DR- I have a coupon. yeah, we'll do focalin with the coupon. you can try it for free for 30 days, how 'bout that?

me- well, actually, my insurance does,

DR- insurance isn't a problem, it's free, see? it's a part of ritalin, I won't go into all that, but pep, it'll give you some of that pep, how 'bout that?

me- well--

DR- kiddos, little kiddos come in here this high ((puts hand at knee)) this high, here, and I give them this

me- ((gives him a funny look))

DR- uhm, not that I like to, but anyway 50, 60 year olds come in here too, just had a few firings at their job, need an extra kick because they have to cover 3people's workloads, give it to them and it helps, it really helps them. are you healthy?

me- for the most--

DR- you look healthy, you look like a healthy girl. I'll start you at 10mg and after 6 days, yeah, try it for 6 days at 10mg then take 20 if you want to, in the morning, you'll probably need 20, a lot of adults I see need 20, 30, 40, 50...we'll see, take 20 if you need it and I'll see you in two weeks

Wham, bam, thank you ma'am :-P

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I think that indicates it's time to get another psychiatrist.

I'm working on it.

I'm 1500 miles from home and my insurance covers nobody down here-- it took me almost two months to get in with *this* guy. While I was waiting for the appointment that I just had, I managed to get my GP to increase my wellbutrin to see me through, but it only does so much--at least I'm not anywhere near suicidal anymore. I DO have an appointment with a reputable doctor when I get home to VT in the summer, but I was hoping for some help before then, you know? I'm trying to see if the doc at home will do a phone consult with me, but we've been playing phone-tag for a while.

anyway, sorry, I feel like I'm such a whiney brat complaining and complaining ;)

I just wish I could stop playing musical-doctors and have someone tell me what to DO. I don't know if I should stay on this focalin stuff, or go back to see this guy, or just cross my fingers and pray that what I'm on currently will get me through?

thank you for the help and input everyone, I really really appreciate it!

meg

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Appointment did not go so hot, question:
  • why do they make you fill out 6 pages of "check this box if you've felt this way in the past this many weeks/months/years" and "check this box if you feel like killing yourself" and "check this box if you've been through something more tramatic that seeing dr.--- for a pdoc" and "check this if your hair is blue" and "check this if your hand is cramping" if they DON'T EVEN READ IT?

Maybe he's doing research? He'll have assistants use it as part of a statistical analysis later?

He's letting me go off of the zoloft (thank GOODNESS) after 6 months of it just making me tired and doing nothing that I know of--he told me to go from my 100mg down to 50mg for two weeks then stop. I'm happy with that choice, we saw eye-to-eye on that one at least. He's not touching my Wellbutrin 450mg even though I told him it stops working after about a month usually and that was my big concern ("we'll deal with that...worry...let me..um" which I took to mean "we'll worry about that when we come to it and you pay me more $$ for a few more appointments") and added a script for 10-20mg of Focalin (one of the isomers in Ritalin) and therefore a Dx of ADHD inattentive. It makes me sleep. Like sleeping beauty but with bad hair and snoring. He charges $25 for every 6 minutes you spend on the phone with him so I can't call him and ask why on earth a stimulant would conk me out like a club over the head.

Focalin is the least stimulating of the stimulants. That also means it has the fewest side effects. It makes you the least jittery. If you have anxiety problems it's a good one to start with if you're not taking anything else for anxiety. If anxiety was part of your reason for going on zoloft, he he might be looking to see how you do on it alone.

The stimulant nervous system paradox where stimulants make you sleepy isn't uncommon in people with ADD.

The fact that he charges for phone calls is bullshit though.

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$25 for 6 minutes of a phone cal??? That's ABSURD. One should be able to call doc and ask a questions without paying. Greedy bastard.

And the guy said he prescribes it to people who need more pep? Where is this guy and can I go? My pdoc laughed at me when I asked for a stim because of my history with abusing meds. Your doc sounds sketchy. And yes, a little crazy. But maybe he is a good doc, hang in there and see how it goes. TIll then feel free to rant on! I love me a good rant.

I see the benefits of changing 1 med at a time even though it will probably take longer. That way you know what med is doing what. My doc does multiple changes at once so if I see a change, positive or negative, I don't know what med did it. It's all a frickin' crapshoot. A test of trial and error. Really annoying.

If you have an ADD dx, you're more likely to engage in substance with it untreated than not. If he's going to be a hard ass but you think stims would really help, agree to pick them up one week at a time and take piss tests.

Take a look at this: (free registration required)

http://cmsprepub.medscape.com/viewarticle/554214

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i have to say, your pdoc sounds like one groovy dude! ;)

i'd say attempt to get a new pdoc. they probably do something with your questionairre, like VE said, probably some statistical analysis or something. maybe they just put it in your chart to see your progress and have some history on you. i dunno. i always wondered why they want to know my cat's life history on those forms.

now- for all you seniors out there- get ready, cause here's focalin!!! :)

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And the guy said he prescribes it to people who need more pep? Where is this guy and can I go? My pdoc laughed at me when I asked for a stim because of my history with abusing meds. Your doc sounds sketchy. And yes, a little crazy. But maybe he is a good doc, hang in there and see how it goes. TIll then feel free to rant on! I love me a good rant.

yep- he's an abuser/college student's dream, lol-- I bet I could go in there and get all the adderall, ritalin, whatever, I just have to look and see what posters he has around his office to see what I could get for free

DR- have you ever been on adderall or ritalin?

me- no, never had a--

DR- nobody prescribed it for you when you were little? adderall?

me- no, I don't--

DR- adderall, ritalin, focalin, yeah, focalin, ever heard of focalin?

me- ye--

DR- I have a coupon. yeah, we'll do focalin with the coupon. you can try it for free for 30 days, how 'bout that?

me- well, actually, my insurance does,

DR- insurance isn't a problem, it's free, see? it's a part of ritalin, I won't go into all that, but pep, it'll give you some of that pep, how 'bout that?

me- well--

DR- kiddos, little kiddos come in here this high ((puts hand at knee)) this high, here, and I give them this

me- ((gives him a funny look))

DR- uhm, not that I like to, but anyway 50, 60 year olds come in here too, just had a few firings at their job, need an extra kick because they have to cover 3people's workloads, give it to them and it helps, it really helps them. are you healthy?

me- for the most--

DR- you look healthy, you look like a healthy girl. I'll start you at 10mg and after 6 days, yeah, try it for 6 days at 10mg then take 20 if you want to, in the morning, you'll probably need 20, a lot of adults I see need 20, 30, 40, 50...we'll see, take 20 if you need it and I'll see you in two weeks

Wham, bam, thank you ma'am :-P

ROTFLMFAO!!!

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He's letting me go off of the zoloft (thank GOODNESS) after 6 months of it just making me tired and doing nothing that I know of--he told me to go from my 100mg down to 50mg for two weeks then stop. I'm happy with that choice, we saw eye-to-eye on that one at least. He's not touching my Wellbutrin 450mg even though I told him it stops working after about a month usually and that was my big concern ("we'll deal with that...worry...let me..um" which I took to mean "we'll worry about that when we come to it and you pay me more $ for a few more appointments") and added a script for 10-20mg of Focalin (one of the isomers in Ritalin) and therefore a Dx of ADHD inattentive. It makes me sleep. Like sleeping beauty but with bad hair and snoring. He charges $25 for every 6 minutes you spend on the phone with him so I can't call him and ask why on earth a stimulant would conk me out like a club over the head.

Focalin is the least stimulating of the stimulants. That also means it has the fewest side effects. It makes you the least jittery. If you have anxiety problems it's a good one to start with if you're not taking anything else for anxiety. If anxiety was part of your reason for going on zoloft, he he might be looking to see how you do on it alone.

The stimulant nervous system paradox where stimulants make you sleepy isn't uncommon in people with ADD.

Thanks VE, that's an interesting take- but I've never had any anxiety issues and I'm about 99% sure that I don't have ADD. Huh. Guess I should just keep on going with the Focalin even though it's doing the opposite of what it was prescribed for? It's only two weeks, I guess I could just take it at night with everything else? just seems backwards, lol.

Hey Loon, thanks for replying ;) If only I was a 'normal' college student, whooo I could have some fun with this doc, lol. Working on finding a new one- hopefully no more hyperquacks for me!

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About the article VE posted in general....

I look at it as substituting a haphazard, patient-based addiction with a physician-controlled one (an extreme example, crystal meth is known in the pharma world as R-methamphetamine and is marketed under the name Desoxyn for narcolepsy).

I don't really see it as "fixing" the individual's SUD, it just controls SUD with proper drugs of similar action.

Better the physician than the patient control the drugs, anyways... in most cases.

That's just my view of things, anyways.

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Hi Meg!

Have you had any luck with the counseling center at your school? The counseling center at my college has one psyciatrist that is available a couple days a week, and with a referral from one of the psychologists there, I was able to get an appointment right away. He didn't actually prescribe anything different for me, but he made recommendations that my regular doctor then prescribed.

But it was entirely free through the school! I know most school counseling centers get bad reps, but they are worth a try. And if they don't have a psychiatrist, they could atleast refer you to another so you could get in faster.

Good luck with everything!

- Micki

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Hey Micki :) thanks for replying

I've been playing phone tag with the counseling center for a while now, trying to get in to one of the talk therapists so I'm not just medicating and not working on that end too...they don't have a pdoc there, they send everyone to the clinic, and the nurse practitioner sends people to pdocs out in the community. She is the one that send me to the adderallhappyguy because she didn't know what to do with me anymore (she was the original prescriber a year ago of my first AD). Anyway, I'm glad your school has that all set in place for you, I wish mine would get it's act together! For heaven's sake, we're an ART college, lol, we probably have a pretty high percentage of 'mentally interesting' students ;)

I'm still trying to figure out what to do. I wish I could call that guy and ask him to try something else that he reccommended, who knows? a stimulant might work for me. I have 5 weeks of school left and I can't just go on what I've got. Even if I don't change my prescriptions I'm still going to need someone to refill them for me. ((pulls hair out)) two exams tomorrow, gotta go, if anyone wants to jump in and tell me what to do, feel free! I'm tired of trying to figure this out :-P

thanks again all,

meg

ps- just keep swimming..

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Why do you think you can't make it until the end of the term without a change? What is wrong with the Focalin? Didn't you just start it two days ago? I guess I may not have read it closely enough but I'm having a hard time understanding what your question is.

Hey, thanks for responding, sorry if I've been confusing, I keep trying to shorten my posts so they're easier to read and then end up leaving out key information :-P

Anyway, I'm really tired right now so I might need to read this tomorrow and edit to make it more coherent, but here it goes:

  • yes, focalin was just prescribed a few days ago but it makes me really tired (conked out for 7 hours in the middle of the day the first time I took it. odd. but IDK, maybe that was a fluke?) I haven't slept that long after taking it since, but I still feel a lot more worn out and exhausted starting about an hour after I take it and have felt like a foggy nausous zombie
  • I should probably stick it out and see if it gets better, but going around nausous and dull during mid-term week? it hasn't been going so well
  • as far as the 'why can't you make it until the end of the term without a change' question-- despite my best efforts (believe me, I'm trying!) I'm sinking into depression again. literally day by day it gets harder to get out of bed in the morning and therefore my schoolwork, personal hygine (ew, really need to do laundry and shower.) and a few friendships have been going downhill with my mood.

    • It's been about a month and a half since I started to really notice this happening and tried to get appointments but the gp who's been prescribing my meds didn't know what to do with me anymore and refuses to change anything- she referred me to a pdoc but it took a month to get in with him (he's the one that prescribed focalin and it's a out-of-my-pricerange-but-doing-it-anyway kinda situation to see him). as much as I wish I could just 'take it as it goes' and follow up and experiment and see him every two weeks, I really just can't financially do it right now

      • by the way, I DO have someone set up for the summer at home where my insurance covers it so I have three months to figure it out on my own time while I'm just working and not going to school, and she's willing to follow up and do therapy over the phone and all that when I go back to school, which is awesome.

I'd rather duct-tape things back together before they completely fall apart.

Sorry for being so long-winded again! Thank you so much for having the patience to read all this, even if you don't have any advice but "stick with it, kid, you'll be fine" it still means a lot that all of you have tried to help and responded and everything,

meg

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The pdoc definitely sounds kinda nutty, but I would say keep with the focalin for another week or so, and maybe it will start doing what it's supposed to do. (think positive before you pull your hair out! ;) )

If it's not working, call the counseling center or the health center and say its an EMERGENCY. Then they will actually have to get you into someone soon instead of just playing phone tag. And if you have to call that pdoc again, at least a $25 phone call is less than another $200 worthless visit.

"Just keep swimming" for another few weeks -- then you get to go home!

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While it's not a diagnostic indicator, sedation from stimulants is reason to read up on ADD a bit. Wellbutrin is a common second line ADD treatment btw. If you've found it more effective than anything else you've been on thus far, there may be a reason for that.

Check these out:

http://amenclinics.com/ac/tests/

More stuff here:

http://www.addresources.org/

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