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Is my Pdoc Nuts?!


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I'm in college in California, and I finally decided to get help for my depression about a month and a half ago.  After being referred to a guy who referred me to a guy who referred me to a guy etc.  (this is what I get for trying to go about this through my college's free counseling and health center) I finally got diagnosed as BP II just last week... long story slightly less long, the doc handed me a mood chart and set up an appointment for two weeks from now.

At the time, I was feeling a little better, but I have continued to feel worse and worse since then.  I'm depressed, but I think I also get mixed states - earlier today I just felt crazy.  Hysterical.  I think I'm too good at putting on my "sane face" and my doc decided that he wanted to wait before prescribing any meds.

Here I am, three days later, ready either to curl up in my bed and never leave or to stab somebody (and/or myself)... grraaarr!

This whole diagnosis, the digging up painful past events, etc. has been pretty hard on me.  What does my doc want from me?  Two weeks of crazy moods?  Two more weeks of screwing up my life, of alienating my friends and relatives, of feeling crappy and crabby and desperate as hell?

Why???

I don't know, maybe I should call him and tell him that I'm barely functional again.  He's nice, but we don't have good communication and I just don't know where he's going with this.

Sorry for the rant, but you most likely understand

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Allow me to tell you a little story about my diagnosis:

I went to the local clinic because I couldn't sleep and my brain felt like it was about to spin out of my head. I met a social worker.

The social worker thought I was messed up enough to see a doctor. Three weeks later, I met the doctor. She quizzed me for two hours, said she thought I was bipolar with GAD, and said she'd see me in a week.

A week later, she reiterated her diagnosis, said I needed lithium, but also announced that she didn't feel comfortable making the diagnosis herself, so I'd have to be reevaluated at the nearest hospital.

Two weeks later, I finally get an appointment. One month later, the appointment finally arrives.

After speaking with me for two hours again, and meeting my out-of-province parents a couple of weeks later, the string of hospital pdocs decides I'm not bipolar at all. I just have a dab of dysthymia, and need therapy.

It took another six months of chaos before I got diagnosed and medicated for real.

I can relate to the runaround and the waiting game when you know you're falling apart. It totally sucks. Calling the pdoc again sounds like a more productive option than doing nothing at all for two weeks. Maybe, upon hearing you in "total wreck" mode, he'll understand the gravity of the situation. We can hope, right? You might not get past the receptionist, but it's still worth a try.

(Topic moved from therapy to bipolar for relevance issues. Yes, we understand. Rant away.)

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Let us know what sort of feedback you receive.  (If you don't receive any, I personally advocate leaving more voice mail messages, leaving notes at his office, and any other legal form of communication you can manage that you need help and this is serious.)  You know better than the average pdoc that bipolar is serious shit.  We all want to see you receive appropriate treatment. 

When I say "all," though, I can probably include your pdoc in that group.  I can see that there is a conflict of opinions here -- you think you need help right now, and your pdoc wants to be cautious -- but chances are that he wants to gather some additional data on the problem (ie your cycling patterns, severity, and symptoms) before starting you on crazy drugs.  It's a good idea to establish what's being treated before treating it.  Among other things, it gives you a baseline of how fucked up you were against which you can measure how you feel once medicated.  It helps an informed pdoc choose the right meds, ones that address your kind of symptoms. 

The trouble here is the waiting.  Two weeks isn't an unreasonable wait under most circumstances, but if you feel truly awful and think you're a threat to yourself or even to others, then you need treatment NOW.  Caution is preferable, but it's a lot easier to treat someone's illness before they attempt suicide than after. 

I guess I just don't want my post to say I think your pdoc is automatically incompetent for waiting, because I don't.  Waiting and observation can be good things for many people.  You, however, are the best judge of how you feel.  If you feel you need help now, you're probably right.  Keep calling.  If the office is near campus, leave notes.  Could the school counseling center leave a message on your behalf?  Sometimes that gets the doctor's attention.  And if you feel you might seriously harm or kill yourself, go to the ER. 

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Thanks for the advice.  He's really good about calling back.  When I talked to him, he suggested that I might be in a mixed state (duh) and that maybe we want to try Depakote instead of Lamictal, but the good news is that he's taking his lunch with me today to discuss this.

I decided that the problem here is my inability to accurately communicate the severity of my feelings.  ;)

Also, I think that if this were not getting toward the most stressful times of year for me, then I would be okay waiting two weeks. 

Deadlines+tests+holiday plans/travel/money+longest depressive episode ever+dealing with the diagnosis = AAAAAAAAH!

Sometimes I escape into a book or movie for a few minutes and when I "wake up" to how my life is changed it's like being hit with water that both burns and chills.

Crazyboards helps me feel less scared.

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I decided that the problem here is my inability to accurately communicate the severity of my feelings.

I think this is a problem that many of us have.  I certainly do.  I'm lucky enough to have finally (after several horrible trials and errors) found a pdoc who can intuitively tell when my thoughts are racing and when I'm doing my best not to burst into tears and crawl under the table.  It DOES take a while to build up a decent rapport with a pdoc, b/c you're trusting them with a hell of a lot of personal stuff.  You're also in the majorly stressful position of having to deal with end of year stuff AND the fact of your new diagnosis.  So be kind to yourself and try to give this guy a chance.  I think it's great that he's taking time out to see you in person today.

One thing I've seen suggested several times is that you either print out your posts here to show the pdoc or write down your thoughts so that you're not completely dumbstruck at the actual appointment (another thing which has easily happened to many people here).

Good luck - I'll be keeping you in my thoughts today.

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I can relate to downplaying your symptoms.  I do that often.  It's a good idea to

write down how you feel and just show it to pdoc at your appointment-that's what

I've resorted to anyway.  I feel ashamed to say some things that I don't give a

second thought to writing.  Good luck with your treatment.

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Skittle and Scatty, your icons confused me for a while!  I thought you were the same person!

The meeting with pdoc was beneficial, but I left again without a prescription.  I'm starting to understand him a little more.  It's just hard not to want to be fixed now.

We ruled out Depakote, and are now considering lithium or one of the atypical antipsychotics.  I personally am stuck...

lithium - I'd have to get waaay better at drinking water, but it's less expensive than Abilify.

Lithium effectiveness predictors say I have an even chance either way.

Pdoc said this made me "interesting."  ;)

Frequent blood tests also sound exciting, especially considering my tiny and impossible veins.

Okay, whining done.

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The blood tests aren't too terribly frequent: one for baseline (thyroid levels, etc), then one every week or so until you've reached a therapeutic dose (for level and at least some effect -- it takes a while to see what Li will do long-term), and then a test every 2-4 weeks for a while to make sure your level is steady, dropping back to a test every few months once you're pretty sure it's steady, because only an idiot wouldn't keep an eye on it.

I don't know if your pdoc is at all connected to the person who would be doing the actual blood draw, but might someone in the area familiar with the medical system be able to let you know where the pricking people are best at listening? If they're aware from the get-go that your veins are tricky, the process might be less frustrating (and painful). It also helps to avoid the needle-wielding sadists. One of my blood draws left a bruise for over four weeks. All the others (and I got an extra special number of them, because of a potential med interaction) went away within days. If I ever see that nurse again, I shall mount an impromptu picket line in front of her cubicle. Dayum.

Um, yes. We now return from Ella's little jaunt down memory lane to say something with some possibility of relevance.

The med thing is trial-and-error for everybody. I'm glad to hear your pdoc actually discusses things with you. This is an encouraging sign. Good pdocs talk. Terms like "interesting" are never fun to hear (a friend of mine, a social worker, once said he thought the word "interesting" should be barred from the English language, but that's neither here or there). Still, though, you could chalk it up to your bipolar mystique. Pull on long black ballroom gloves, toss your hair, and say "yes, I am a fascinating case...."

Ella will go eat dinner now, before she starts telling you about pet squirrels.

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I decided that the problem here is my inability to accurately communicate the severity of my feelings.
Oh yes, the "sane face" phenomenon.  I'm great at seeming perfectly fine while my insides feel like they're about to explode out onto the pavement.  It's a curse.  It took years of therapy and meds for me to finally be willing to be real with my pdoc and therapist.  Pdoc doesn't appreciate the honesty; I'm glad your doc does.

But IMHO it sounds a little like he's playing with fire by waiting for weeks before giving you anything at all to stabilize you.  If you're bouncing around and feeling significantly worse and having horrible mixed states, it's frankly a little dangerous, no matter how sane your face is.  The diagnosis is a shocker and it's a trigger in and of itself.  I'm sure you'd rather avoid a situation where you're at the ER at 3am getting a stiff dose of tranquilizer or zyprexa or something else you don't really want to be driven to.  It's what you'll have to do if you're spinning out, but that is avoidable if you start meds.

I dunno.  Maybe I'm being alarmist.  I just remember how scary it was to sit there quivering with insanity and being so grateful for zyprexa.  There was no reason it had to get so bad, except the irresponsible pdoc who left me on wellbutrin without any stabilizer.  I know this isn't the BP meds site, but I can't help myself.

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NARS - I feel much better after reading your post.  I was feeling like I was being a bit whiny or something, but from a little better perspective I know that calling the pdoc was the right thing to do.

When I confessed how hard it was to make the call, he looked at me and said, "I know." 

This is why I'm starting to like him.

What's wrong with your pdoc?!  It seems to me that being honest would make the job easier.

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This is why I'm starting to like him.

You have no idea how GOOD it is to hear somebody say this.  A good pdoc!  Hooray!  Are you pro- or anti-balloon?  I can make flowers and fun little animals in celebration.  Maybe even get you some fishnet stockings to complement your fabled allure. 

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First, let me get this straight.  Am I right to assume the doc who diagnoses you is the one who will be treating you?  If not, ignore the following.  If so, why the hell did he make you wait 2 weeks to start you on your meds!?!  We all know how serious and dangerous BP is, why take the risk of making you wait 2 weeks or even 2 days to start you on the meds that could easily save your life?

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It's not actually that pdoc doesn't like honesty, he just hates it when the news is bad.  I'm partly to blame here.  I quickly learned what the "right answers" were to his list of diagnostic questions and that he worried and fussed if I gave the "wrong answers."  So long as I was not going nuts again, I tried to give him right answers and minimized the anxiety and irritability I still had.  His clients are almost all inpatient and detox, so he's used to being in charge and not giving patients much of a choice.

I'm calling another provider today to get the name of a slightly younger pdoc who's not only familiar with BP treatment but takes a more wholistic approach.  I'm going to be frank with him and won't switch unless he has a good approach, won't insist on radical changes, knows his psychmeds interactions, and follows a modern treatment algorithm.

Demanding?  Yes.  I've learned I need a pdoc who'll work with me to make me not only functional but thriving.

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Nars, good for you!

and I don't think it's being demanding. You are entitled to have to doc (any doc) listen to you with respect and courtesy. If h/she can't respond with them, along with being professional, get rid of 'em.

Life is too short to put up with crap unless you really have no other choice...like stranded on a desert island? And even then, well, there are coconuts.

spike

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