Posted by mixedstates on May 4, 2002, at 12:41:07
In reply to help! (rant; advice?), posted by Elizabeth on April 19, 2002, at 1:52:57
> A few months ago I moved and had to find a new pdoc. She seemed pretty good at first, but it turns out that she has a lot of attitudes and assumptions that I recognize because a lot of people on PB have reported similar behavior in their (your) doctors. So I'm hoping someone here has some idea how I might approach this problem.
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> This new pdoc wrote a prescription for Xanax as-needed, but she only gave me 10 doses per month (keep in mind that Xanax is a short-acting drug -- I think it wears off in about 4-6 hours for a typical adult). This month I ran out early and had to ask her to call in a refill. When I saw her the other day, she asked me if I'd been "overusing" the Xanax. (She said this in a way that strongly implied that she felt that I'd "overused" it the month before. The way I see it, the amount she'd prescribed hadn't been adequate.) I tried to explain that I'd been having problems with insomnia and back pain that had contributed to my need for more Xanax than the amount prescribed. Then she got freaked out and accused me of abusing it -- it's "not indicated" for those problems, and so forth. I explained that insomnia and muscle tension can be symptoms of anxiety. She gave me the generic heard-it-a-thousand-times lecture about how I should find other ways to "manage" chronic pain. (I've tried all that stuff, and besides, I don't want to "manage" it, I want to treat it!) In the end, she wrote another 10-dose prescription for this month.
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> I also told her that I'd been having problems with early-morning depression sometimes, which I speculated was caused by the last buprenorphine dose of the previous day "wearing off" overnight. I don't remember exactly how I phrased it, but I did think it should have been clear what I meant. She somehow managed to interpret it to mean that I was becoming tolerant. (She also claimed that if I was becoming tolerant, it must be because I was using it to get high. Tolerance to benzos occurs almost exclusively in the context of abuse, but this isn't necessarily true of opioids. I didn't bother telling her that, though.) I pointed out that I had said "wears off," not "stops working." She backed off a bit, but she didn't think that this problem was worth doing anything about. (I'd thought that a small bedtime dose of buprenorphine might be worth trying, but I was scared to make that request after she verbally jumped on me -- it made me feel like I didn't deserve it, you know?)
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> After all this nonsense (all in a single appointment, mind you), I was faced with having to remind her (I had told her this before) that I need 20 mg/night of Ambien, that 10 isn't adequate (I asked for a prescription for Ambien because I haven't been sleeping very well -- she put up a little resistance to this, too, of course, but compared to the other stuff, she was being very rational and laid-back!). Some background: I first took Ambien in 1996 and it has always been clear that 10 mg isn't effective, but 20 mg is (it's not like Ambien just doesn't work for me or I grew tolerant from "overusing" it or something). She insisted I "try" 10, even though I told her that she could confirm what I was telling her by talking to the pdoc I'd seen while I was in Boston. This is a big problem for me because I don't have another appointment for two months; sleeping fitfully and inconsistently for that long is bound to have nasty effects. This pdoc talks about wanting to see functional improvement from the medication, but she doesn't seem to want to do what it will take to bring about that improvement.
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> I don't abuse or misuse or overuse any drugs, including psychiatric medications; and I've always been responsible about my use of medications, in particular of those prescribed for as-needed use. So the way my new pdoc has been acting is naturally off-putting -- it's clear she's just assuming that I'm up to no good, for some reason. (What that reason might be is a mystery to me: I've *never* gotten this much crap about supposed "drug abuse" from any doctor I've seen.) How am I supposed to deal with this woman??? I want (and need) her to trust me, but she seems bent on mistrusting me. What can I do/say?
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> Any ideas?
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> -elizabethElizabeth, I am so sorry to hear about this awful situation. Also sorry for my tardiness in responding as I have been away. To begin, donot let your new pdoc make you feel bad. You are extremely bright and very articulate. Your eloqquently written posts are always a great help to me especially your maoi posts, as i am an maoi user. It is unfortunate that your pdoc is not allowing you to be a partner in your treatment plan. I find that totally unacceptable in the treatment of bipolar which can be so unique from patient to patient. I am very glad my doctor allws and encouurages my involvement. I also use ambien and my pdoc put me on 20mg right from the get go as he said the standard 10mg would not work. He also said that when I am cycling and with mixedstates that I may need 2.5 or 5mg of zyprexa and he let me decide the dose as only I would no how it worked best for me. I also take xanax as anxiety is a large issue for many bipolars(your doc should have been sensitive to this). my doc lets me take it prn but allowed me to give him my estimate of how much I need each month. I know you will "hold your new pdocs feet to the fire" and make her let you partner in your treatment. Again your words and info have meant much to me and I wish you the very best.
mixedstates@msn.com
poster:mixedstates
thread:103496
URL: http://www.dr-bob.org/babble/20020503/msgs/105040.html