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Hi, it's me again.  I wanted to report on my visit to the new pdoc. 

Yep, he's my guy for now.  He's nerdy like me but not as antisocial as my old pdoc, who sat behind a huge desk and 2 computers during our visits and spent his time typing my answers to his standard set of questions.  This guy not only sits in a chair with his feet on an ottoman, but provides a matching chair and ottoman for the patient.  And spent 2 hours on the evaluation paying very close attention and asking intelligent questions.  And he's all for patients doing research. 

His direction is to drop my afternoon thyroid meds and move the 300 mg of lamictal to the evening, and then after a week get blood levels of lamictal and DHEA.  I'll see him in 4 weeks unless something dramatic happens.  Then if I'm still having trouble we'll consider a low dose of tegretol, lithium, or topomax.  I'm pretty paranoid about tegretol because of my terrible depression during tegretol monotherapy, but he pointed out that until I dropped the depakote entirely I saw a huge improvement in my sleep and quashing of signs of mania.  Since lamictal is much kinder to me that depakote, I might even get better results from a little bit of tegretol.  If not that, then we'll try something else.  He definitely sees a cocktail in my future.

I feel so reassured by his thoroughness.  Who knows how it will work, but I liked him and he comes so highly recommended that I'm willing to take the chance.  Now I feel like I can withstand some of what's going on, knowing that I'm working with someone good.

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Heya NARS,

Great to hear your new guy looks so good.

Having had a similarly hopeful first meeting with my new guy 2 weeks ago, I know how encouraging it is to talk with someone who makes sense.

And what a relief it is.

There *are* good psychiatrists out there.

Hope your rapport with this guy continues to be positive.

--ncc--

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Hi NARS,

Isn't it wonderful to have someone who will spend quality time problem solving with you?  My out-of-pocket pdoc is like that, I feel positive for days after seeing her. 

Definitely a good sign that your new guy wants to test DHEA levels, most pdcs won't propose that.  Will he be working with your GYN?  I don't mean to pry, but have you ever had your testosterone levels tested?

Ottomans are always good.

Hoping you soon feel better with your new regimen,

Yvette

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Just out of interest, have you ever considered Tegretol Retard instead of regular Tegretol?

I started a new cocktail on Monday, which includes Tegretol Retard instead of regular Tegretol. Though I think the valproate has played the larger part in my feeling much better, I do wonder if the Retard is suiting me better then the regular form of Tegretol.

Just a thought.

(and glad your new pdoc seems so good)

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hey sweets...

that's such good news...i feel if you don't like who's treating you (which actually holds your life in their hands)...then they aren't gonna be able ta help you as much as someone who you trust and feel comfy with!!!

good luck with your journy it sounds like you're off ta a great start!!!

good thoughts ta you n good luck!!!

flutterfly xo

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Whatsgoingon, I didn't seem to have problems with tegretol levels dropping noticeably.  Since you're on valproate, you're likely to be clearing tegretol very quickly.  But I'll keep the extended release version in mind.

Yvette, the new doc asked specifically whether he could talk with Sidne, and of course I said yes.  He knows her (she teaches seminars), and will no doubt review the hormonal issues with her.  He came up with the DHEA by himself.  Ironic that an acupuncturist I saw on Tuesday told me I need DHEA.  The pdoc thinks it's possible that the T3 (liothyronone) is aggravating the hot flashes and hurting my sleep; that's why he wants to start there. 

Anyways, the pdoc is about as baffled by my reaction to estradiol as Sidne is, but he's open to trying to figure the whole thing out.  But unlike my old pdoc he didn't tell me it's impossible for me to have that reaction.  He just said he hadn't heard of it but paid attention to the issue.  Very nice.

I'm still pretty labile today.  A few hours ago I got incredibly pissed at something someone did here at work (long story).  Now I'm delighted because another guy, all by himself, called me about a serious problem that I've been worried about and am about to ask for a meeting on, and he's all excited about fixing the problem.  What timing!

I'm going to take it easy over the weekend and take 2-3 days to switch the lamictal to the evening.  I've been thinking anyways that this alone may make some kind of difference.  Who knows.  As my therapist says, it's alchemy.

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