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Hi,

I don’t quite know where to put this post so I’m hoping placing it here is a good fit. 

Apologies for the long read but I could really use some help at the moment. 

This post is about changing pdoc’s which I’m apprehensive about and I would like to receive peoples thoughts on as I’m in a vulnerable situation at the moment. 

From my recent pots you’ll note that I’ve gone through a particularly tough time recently since having ECT and being discharged as an inpatient.  

Going back to 2013 when I was previously an inpatient I was assigned a pdoc at the hospital I was at who was unlike others that I had met over the years. Let’s call him Dr K. 

Dr K actually seemed to care about my wellbeing and family and seemed to bring stability into my life in terms of medication treatment, even though looking back now the treatments that he recommended didn’t result in a great improvement in my symptoms over the past five years and landed me back in hospital recently. 

Dr K is extremely conservative and a big believer in conventional treatments such as ECT and lithium augmentation neither of which have really helped me. 

Having treatment resistant depression I’m always looking for a treatment that might help my symptoms and I refuse to give up and accept my current state and will look for anything that may help my situation. The problem is that Dr K doesn’t like to rock the boat and tries to keep me stable which I respect even though looking back over the past five years since he’s been my pdoc hasn’t really helped me. 

I’ve basically kept my head above water but I’ve been drowning for a long time is the best way to describe how I’ve felt over the past couple of years. 

Looking for anything that may help me feel better has resulted in him branding me as a person who is ‘chasing that magic pill’ and being told that ‘a magic pill doesn’t exist’ and being disregarded in regard to any recommendations that I have made to potential treatments. 

I guess the real turning point was when I was in hospital recently and where refused further ECT treatments after four courses because I couldn’t physically and mentally go through anymore because of the PTSD I experienced last time I went through ECT as an inpatient in 2013. 

Although I was relatively unwell over the past few years Dr K kept pushing for me to go into hospital even though this affected me negatively. I kept refusing on the basis that being an inpatient and having ECT traumatised me and it’s something to this day that I haven’t gotten over and suffer PTSD from. 

Unfortunately my depression came back with a vengeance in late December 2018 and by early January 2019 I had no choice but to go into hospital because functioning in daily life was not happening. 

I went into hospital and was at a really low point in my life and ECT was suggested again. Being at the lowest low and having nothing else to lose I stupidly agreed to go through the treatment as I was in such a bad position.  

I won’t go into it in detail but you can read about it my ECT post. 

After going through four treatments I was incredibly depressed, extremely anxious and in a fragile vulnerable position following ECT. 

When I met with Dr K instead of supporting my decision to stop ECT treatments I was berated and told I was being a difficult patient, that I was dictating my own treatment and that I was making it difficult for him to treat me. 

After crying me eyes out in front of him telling him I couldn’t go through any more ECT he threatened to walk away from me as my treating doctor and that he wouldn’t prescribe a MAOI that I originally came into hospital to change over to. 

He ended our appointment with an ultimatum that he would be back in two days and ‘to think about what I wanted to do’. In other words go through ECT or else. 

Two days later I met with him again and after crying my eyes out he reluctantly agreed to stop ECT treatments and to start Nardil. 

All of this has really traumatised me and left me with no confidence with Dr K. 

It’s also concerning that I’ve been told by Dr K that I’m at the end of the line in terms of medication treatment options and the only way forward is to up my Nardil from 45mg currently to 90mg and to augment this with Lithium. 

Beyond this he’s really not suggesting anything else besides inpatient ECT and outpatient maintenance ECT, something I’m not able to revisit.  

While I was an inpatient and I had time on my hands I did some research on other pdoc’s who work with treatment resistant patients and that are willing to prescribe MAOI’s and other treatments such as stimulants that other pdoc’s and that Dr K won’t prescribe. 

I met with a new pdoc today for an initial consultation, let’s call him Dr C. 

Dr C basically took a thorough history and although he didn’t mention any treatment options at this first appointment, he was incredibly attuned into my treatment resistant depression and told me that I was incredibly patient with what I had put up with over the years and that there were a number of treatment options that we could explore and that I wasn’t at the end of the line.

I guess I’m now at a point as to whether I ditch Dr K and go with Dr C. 

I guess I feel incredibly conflicted as although Dr K has tied to do the right thing by keeping me stable and functioning, looking back I haven’t been well for a long time.  

I also feel strangely obligated to Dr K for the support he has provided over the years but I’m also incredibly upset and hurst with the way he treated me in hospital when I was in such a fragile state. 

I’m nervous and anxious about starting afresh with a new pdoc, however I feel that a new pdoc such as Dr C might be my best shot at getting better. 

Although I find it hard to admit I don’t really see a long term future with Dr K but I feel comfortable with continuing on with seeing him as I don’t like change. Perhaps I have a strange case of Stockholm syndrome going on. 

As I mentioned above I’m not in the best state at the moment following what I’ve been through and how I’ve been treated but I’m conflicted due to the time I’ve spent with my treating pdoc Dr K. 

I’m also seeing Dr K next week for a follow up appointment as an outpatient at his request which I will attend. 

Dr C today asked me to take some blood tests and to see him in a couple of weeks I guess to see how the Nardil is working as I’ve only need on it for two weeks. 

I would really appreciate any advice in regard to changing pdoc’s especially from those who have shared a long doctor / patient history. 

I’m not looking for words of encouragement but just straight forward advice as what’s the best for me to do. 

Thank you. 

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6 hours ago, Rambler76 said:

  I’m nervous and anxious about starting afresh with a new pdoc, however I feel that a new pdoc such as Dr C might be my best shot at getting better. 

I think everyone is somewhat anxious when switching to a new pdoc............Last year I was forced to switch docs, because the doc I had for past 5 years moved.....I really liked my old pdoc and was somewhat traumatized by her leaving.

Anyway, I think that if you truly feel "Dr C" could be your best chance at getting improvement, you should go with your gut on this and switch to Dr C.......I understand your feelings of loyalty to Dr K after 5 years, but sometimes it really does help to get your situation looked at with a fresh pair of eyes, IMO.

Edited by CrazyRedhead

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The only thing that concerns me about your current pdoc is that he might be too conservative. I spent most of my adult life with doctors like that and tried med after med without results. Then I was hospitalized and fell in with some great pdocs who were not afraid to think outside the box. What helps me is a combination of an antidepressant + antipsychotic + anticonvulsant. My stimulant helps too. Earlier no one ever suggested such a cocktail. I feel that I was very lucky to have found these pdocs and they listened to me.

I'm not suggesting that my cocktail would work for you because we are all different, but what I'm saying is that if your pdoc isn't willing to build such a cocktail with you, it might be time to move on. There are great pdocs out there.

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So there’s no way to guarantee that someone new would work out—but it sounds like you can guarantee that the present one isn’t working.  It sounds like his philosophy doesn’t match yours and he isn’t open to you being involved in your treatment.

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6 hours ago, CrazyRedhead said:

I understand your feelings of loyalty to Dr K after 5 years, but sometimes it really does help to get your situation looked at with a fresh pair of eyes, IMO.

You are correct. 

Although Dr C didn’t mention any specific treatment options he did make some passing comments about medications that I have been on, and medications that I haven’t been on that may be beneficial. 

I guess I’ve been stuck in a comfortable rut with Dr K for so long I’ve just accepted the way things are and have just gone alone with feeling the way I have been because I’ve been told that’s as good as it will be. 

Perhaps a new pair of eyes and a different approach is what I need. 

I know deep down this is correct but being unwell at the moment makes it difficult to accept. 

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5 hours ago, jt07 said:

Then I was hospitalized and fell in with some great pdocs who were not afraid to think outside the box. 

I guess this might be happening to me as well as I came across Dr C while I was in hospital. 

Dr K is really conservative and won’t do anything  that isn’t a classic textbook approach. 

Dr C from taking my history did make some passing comments about other medications and combinations that would work on my biological depression and would target specific receptors that he thought I had a problem with.  

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4 hours ago, dancesintherain said:

So there’s no way to guarantee that someone new would work out—but it sounds like you can guarantee that the present one isn’t working.  It sounds like his philosophy doesn’t match yours and he isn’t open to you being involved in your treatment.

I guess I have nothing to lose at the moment and don’t believe a lithium augmentation strategy which I’ve tried in the past will help if Nardil doesn’t come through. 

You’re correct my present situation isn’t working and I don’t think it will work in the future if I start to become unwell again. 

I feel that I’m just prolonging my pain staying stable but barely functional. 

I guess I need some drastic action and changes to feel better and my old pdoc isn’t going to deliver this and isn’t open to my suggestions.

 

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7 hours ago, jt07 said:

The only thing that concerns me about your current pdoc is that he might be too conservative. I spent most of my adult life with doctors like that and tried med after med without results. Then I was hospitalized and fell in with some great pdocs who were not afraid to think outside the box. What helps me is a combination of an antidepressant + antipsychotic + anticonvulsant. My stimulant helps too. Earlier no one ever suggested such a cocktail. I feel that I was very lucky to have found these pdocs and they listened to me.

I'm not suggesting that my cocktail would work for you because we are all different, but what I'm saying is that if your pdoc isn't willing to build such a cocktail with you, it might be time to move on. There are great pdocs out there.

i agree. My current pdoc suggested ECT very early on. I told him no, i wasnt doing it, period. I told him i had tried many meds, and gave him the lengthy list. I said i had some bad doctors that ripped meds in and out of me and didnt give them fair trials. That there were many meds and combos not explored yet. That i wanted a doctor that would work with me to try and find the solution without ECT. He said well ok then, lets try this, and away we went

2 hours ago, Rambler76 said:

I guess I have nothing to lose at the moment and don’t believe a lithium augmentation strategy which I’ve tried in the past will help if Nardil doesn’t come through. 

You’re correct my present situation isn’t working and I don’t think it will work in the future if I start to become unwell again. 

I feel that I’m just proldonging my pain staying stable but barely functional. 

I guess I need some drastic action and changes to feel better and my old pdoc isn’t going to deliver this and isn’t open to my suggestions.

 

just keep in mind that becasue lithium ddidnt work in the past, it may work in combo with other meds............

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I don't know about you, but I wouldn't be able to see an "authoritative" doctor. I like being able to discuss options, treatment, side effects, make suggestions, etc... I much prefer a collaborative approach. You want someone who listens, and is open. If he's stuck in his ways, seeing him makes you stuck in your own. It isn't productive. 

Besides a new perspective can make a lot of a difference. 

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Thanks for the responses everyone. 

I saw my new pdoc Dr C on Friday and he’s a  really awesome guy who’s willing to listen and work together with treatment resistant patients like me. Much more than my old pdoc  

He’s really knowledgeable on the pharmacology side of things much more than my old pdoc. 

He seems more focused on patients than my old pdoc who was primarily focused on side projects I won’t go into rather than his patients. 

I guess this was a lesson learnt for me that if my pdoc is stuck in their ways, then it’s time to change and have a fresh approach and a fresh pair of eyes look at my case. 

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