netsavy006 Posted March 23, 2009 Share Posted March 23, 2009 Today I went to a pdoc (not my regular one; she wasn't in) because I was having thoughts of changing my medications around. I told this pdoc my concerns about Zyprexa (increased lipids, increased cholesterol, increased triglycerides, increased risk of diabetes compared to other meds), and she told me that there is a 1 in 10 chance that increases in cholesterol/lipids, and elevated glucose happens. She told me that you get kept on the medication until there is a problem. Then something is done about it. Then I had mentioned that I prefer Abilify because I like the way I feel on it. She asked me what dosage was I on now and I told her I was on 5mg per day. She told me to increase the Abilify to 10mg a day and leave everything else the same and see my regular psychiatrist to discuss my med options next week. I really don't agree with her statement about the 1 in 10 chance of increased cholesterol and glucose, but then again I'm not a doctor so I don't know these things. I hate how I have to be in control of the medications that I take. Mom asked about a lowering of the dose of Zyprexa and the doctor said not to do that because that would cause a 'gap' and that she wanted to avoid. So for now I'm stuck on two anti-psychotics and I don't like it. I'd rather be on the Abilify. In accordance to the website at least, it doesn't increase cholesterol and only has a median 5% increase in triglycerides. That's better in my eyes than Zyprexa's profile, but like I said, I'm no doctor. What can I do to stop this ridiculous habit of playing with my medications like this and let the doctors do their job of treating me? Thanks for reading, Andy... Link to comment Share on other sites More sharing options...
AirMarshall Posted March 23, 2009 Share Posted March 23, 2009 ummmm Take an index card with you to your next appointment. On one side write "I will keep my mouth shut", and on the other "Yes, thank you doctor". Keep reviewing the card. Goodluck a.m. Link to comment Share on other sites More sharing options...
tryp Posted March 23, 2009 Share Posted March 23, 2009 Hey Andy, Maybe you've said this before, but have you ever specifically spoken with your pdoc about this issue? I know your pdoc knows it's a problem, but have you ever actually told her how anxious and agitated and obsessive you get about meds and asked her for advice on handling that anxiety? If so, what does she suggest? I can't really see any reasonable pdoc listening to the kind of anxiety you get and not offering some sort of constructive help. Also, much as I hate to harp on the therapy thing, I still think this is a good example of a concrete goal you could bring to your pdoc and say "this is a specific goal I want to work on in therapy. What can I do to convince you that I can handle therapy?" Because it seems like there's nothing pharmacological that will help your anxiety, and it doesn't seem like you can manage it on your own. Tryp Link to comment Share on other sites More sharing options...
netsavy006 Posted March 23, 2009 Author Share Posted March 23, 2009 She tells me not to do inter-surfing which I guess is not looking up the medications online and reading about the effects/side effects, but I already know them in my head so what good that does for right now. I was already able to present them to a p-doctor so I was able to memorize some of the effects of the Zyprexa. That's what scares me. I know too much about the medications. I'm overdoing it and am too informed. I was too excessive and obsessive that now I have it all in my head. She tells me not to play doctor and for her to be the doctor and for me to be the patient and for me to listen. Mom suggests for me to be busy doing things and be occupied so I'm not thinking too much on the meds and focused too much on the meds and I think she might have a point there. That's all I can really say for the moment. Link to comment Share on other sites More sharing options...
tryp Posted March 23, 2009 Share Posted March 23, 2009 The keeping yourself busy is definitely a good idea, but if you've already got the obsessive worries in your head, it's probably too late to stop them by not reading up on the meds. You really might want to try to get something a little more constructive out of pdoc. I could be wrong, but reading your posts, this seems like a major barrier to treatment for you, and I would really pull out all the stops trying to address it. Obviously, I'm not a pdoc or anything, but it sounds like this is a really big problem and maybe your pdoc doesn't understand just exactly how difficult it makes things, because her advice sounds sort of like telling someone with MI to "just stop" and we all know how far that goes. Nothing against your pdoc - I'm sure she knows her shit. I just wonder if she understands the magnitude of the issue. Because from where I'm standing, you sound pretty damn anxious and obsessive. Link to comment Share on other sites More sharing options...
netsavy006 Posted March 23, 2009 Author Share Posted March 23, 2009 But now the question becomes how do I stop? That's what I'd like to know... Link to comment Share on other sites More sharing options...
tryp Posted March 23, 2009 Share Posted March 23, 2009 I'm no expert, but I'm thinking maybe CBT could take care of reframing some of that stuff for you. Never got too far with it myself, but some people swear by it. Maybe someone else who knows more can chime in. Personally, I happen to know a helluva lot about psych meds - my pdoc is often surprised by how much I know, and I keep a lot of what I know to myself. As a physiology major with some hardcore anxiety issues, I have ample ground for obsessing and second-guessing and worrying about meds. As to how I stop? For me, it's just about having a really good relationship with my pdoc and knowing that she wants what's best for me and is better equipped to figure out what will work than I am. It helps that she's also my tdoc and at this point, she and I go back a fair length of time and she's gotten me out of some nasty spots. But telling you to decide to think like that would be like saying "Just stop" so I guess maybe I just got lucky. Link to comment Share on other sites More sharing options...
gizmo Posted March 24, 2009 Share Posted March 24, 2009 But now the question becomes how do I stop? That's what I'd like to know... You can start by limiting how long per day you are at the computer. To do that much surfing for meds, you must spend hours a day on the net. I've seen you post on other sites, so I know you are involved in other MI communities. That takes time. Surfing wiki, medscape, pubmed, etc, that takes time. Like my favorite cooking tv host says, "Just walk away! Just do it!" Go to friggin therapy!!! Don't tell your pdoc and just go to therapy. Talk about your medications for 50 minutes once a week and let it all out. Then once you get all of the toxic med junk out, then you can focus on behavior techniques to help you cope with your obsessive tendancies with meds. You are going to have to learn to accept the fact that you will never get to live with the "high" feeling that 15mg of Abilify gives you. You've admitted that this is basically the only reason you keep pushing the abilify despite the fact that you KNOW you get akathesia with that dose. I can only chalk it up to your age. Because if it's not, then you are chasing the high, and that's really not good, is it? On the same subject, my diagnosing doctor told me that the hardest thing I was going to face with being diagnosed (and treated) for bipolar would be the loss of my (at the time) hypomania. Because it felt so damn good. And with proper treatment, it goes away. I wonder if you've made peace with the loss of your hypomania. If not, this would be a good time. Because you just convinced a doctor to change your meds for absolutely no reason when you had absolutely no symptoms, other than your obsession over abilify. Be careful of what you ask for... If I were your doctor, I would put a big "Do not give this patient Abilify" post-it in your chart. But then, you'd probably just change pdocs. Link to comment Share on other sites More sharing options...
netsavy006 Posted March 24, 2009 Author Share Posted March 24, 2009 After leaving the p-doctor's office and making the appt. for my regular psychiatrist the following week it made me reflect and it made me think that I was a bad person. (which I know I'm not but that's how I felt). It made me feel more anxious and nervous because now what am I to do? I'm overly worried because this is what I was doing before I went into the hospital. (changing med doses and medications). And now I'm afraid that my regular psychiatrist will do exactly what she was going to do prior to my hospital stay (close my case and say good bye to me and I don't want that). I know I did this to myself but now I hate how the bipolar controls me more than me controlling the bipolar. This was the plan that the other pdoc set up: 1. Raise Abilify to a stable dose 2. Get Abilify at the stable dose for a period of time 3. Work off Zyprexa when the dose of Abilify is stable for x period of time. I just feel so bad now to because with my current pdoc sick I feel like I went behind her back and did things and I know I shouldn't be doing that either. I have discussed therapy with my pdoc in the past and we tried family therapy and she told me I didn't open up to the therapist. Then she tells me I set med goals so I can't have a therapist for that reason. I'm just glad to have a case manager, but she says that she's not here to discuss medications, only if I'm taking them appropriately and if I'm keeping my doctors appts. and that's it. I told my case manager that I have this obsession problem with the medications and that's what she told me in regards to that. I just hope that I can keep my regular pdoc and not have problems when I see her next week because of what I've done this week. I will explain everything that was going on and maybe things can change for the better... Link to comment Share on other sites More sharing options...
tryp Posted March 24, 2009 Share Posted March 24, 2009 I don't think you're a bad person, but I think you're caught in a bad place, and the truth is, your pdoc is probably going to be displeased with you. If I were you, I'd scrap everything stranger-pdoc told you to do yesterday and go back to what you were taking before - what your pdoc told you to take last time you saw her. That's probably about the only way to make the situation better. Also, I tend to agree with Gizmo - you really need to find a way to get some therapy on board, for reasons everyone has enumerated before. If you need to go behind pdoc's back, now WOULD be a good time to go do that. Link to comment Share on other sites More sharing options...
netsavy006 Posted March 24, 2009 Author Share Posted March 24, 2009 Do you guys think it would be a good idea if I got a release form signed for the case manager to have communications with my pdoc so that she may be able to help me obtain therapy? Link to comment Share on other sites More sharing options...
gizmo Posted March 24, 2009 Share Posted March 24, 2009 This was the plan that the other pdoc set up: 1. Raise Abilify to a stable dose 2. Get Abilify at the stable dose for a period of time 3. Work off Zyprexa when the dose of Abilify is stable for x period of time. No, this is the plan you manipulated the alternate pdoc into giving you, just as you have been wanting for weeks. Be honest. I have discussed therapy with my pdoc in the past and we tried family therapy and she told me I didn't open up to the therapist. Then she tells me I set med goals so I can't have a therapist for that reason. A pdoc, by definition, manages your medications. Nothing else. Do you seek you pdoc's permission to see a GP? How about an ER doctor when you fall? Then why do you continually think you have to have the pdoc's permission to see a therapist? It's like you're using your pdoc as a reason not to see one. I'm sorry to be so brutal with you, but everyone here has put on their kid gloves with you for the past month, and you've just waived past their advice and worked yourself into this nasty little corner. Now is time to face facts, and prepare to reap the benfits of your actions. A good therapist would likely help you through this time. Tryp's suggestion of not changing your meds is a really good idea. Seeing your regular pdoc and admitting what you did would be another good idea. Getting some help for your obsession would be an excellent idea. Link to comment Share on other sites More sharing options...
tryp Posted March 24, 2009 Share Posted March 24, 2009 I think it's always a good idea to have members of your care team talking to each other, and if she'll support you on the therapy thing, I'd say go for it. Not much to lose there, after all. Andy, I feel a lot of sympathy for you, because I'm a total neurotic basketcase and I know what it feels like to obsess about stuff and worry about your meds and feel impatient and all that. But I have to say, much as I want to give you support, I tend to agree with Gizmo - it's time to really get on this therapy thing and fix things with pdoc. Link to comment Share on other sites More sharing options...
netsavy006 Posted March 24, 2009 Author Share Posted March 24, 2009 No, this is the plan you manipulated the alternate pdoc into giving you, just as you have been wanting for weeks. Be honest. Being honest, I did tell her that I didn't like Zyprexa and preferred to be on Abilify. I could be wrong about the plan, because she never wrote one in the chart. She did ask me how much Abilify I was on and I told her 5mg/day and she told me to increase it to 10mg per day. (the increase is in the chart). Before leaving, Mom asked her if she was going to decrease the Zyprexa and she said not to do that because it would create a 'gap' (whatever that is) and she didn't want that to happen. So based on that evidence, that is what I believe is going to happen. This could be totally false when I see my pdoc next week. She may change what is going to happen. I asked my mom yesterday if the Cogentin is helping me and she told me it is so we will have to see if the 10mg/day of Abilify will be 'compatable' with the 1mg 2x/day of Cogentin. I sure hope so... I tell my pdoc I'd like to attend therapy and she has to put something through for that. Then she comes back to me to let me know what happened. It seems to always come back as a failure for one reason or another. (mainly because I have too many goals and they relate to medications). One time it was because I didn't open up to the therapist (and that was family therapy (Mom & me; pre-bipolar dx). Link to comment Share on other sites More sharing options...
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