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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by Tabitha on March 9, 2003, at 18:54:30
I tried a new pdoc and I think he doesn't know what he's doing. It's hard to believe.
- he put me on 150mg doxepin as an add-on for insomnia. this is the wrong dose--it's a full antidepressant dose, but I'm bipolar and already on celexa. a sleep add-on dose should be small, maybe only 10mg.
- I told him I've had trouble with tricylics before causing pounding heart. he told me doxepin is not a tricyclic, it's a tetracyclic. I looked it up and it's a tricyclic.
- he told me doxepin has no side effects except sedation. again, wrong- it's listed at the top for antihistamine effects.
- the trial was a disaster. I doubted the 150mg dose so I tried 100mg (this was before I looked up dosing) and it was still the worst med trial ever. I got severe pounding heart, a sick paralyzed panicky feeling, woke up several times in the night with completely dry mouth, overslept by several hours, then the next day felt too groggy to drive, and had the worst food cravings ever. the grogginess and food cravings lasted all day. then I was bloated for days from all the binge eating.
- I asked him what he thought of lamictal and he said it was good for mania. Everyone here says it's good for bipolar depression and does nothing for mania.
Am I missing something? how can a pdco be so wrong so many times. This guy was recommended by my therapist based on other clients using him. This is like what you'd expect from a really incompetent GP who doesn't follow psych meds at all.
It's really discouraging. He charged my insurance $200 for this experiment. I've gone to bad pdocs before but they were HMO docs. This guy is private practice. I don't know how to find a competent doctor without wasting time and money like this.
The other thing is I hate the new patient interview. It's so humiliating having to lay out my whole history to a total stranger, having it go into his files, all for nothing.
Posted by ace on March 9, 2003, at 18:59:53
In reply to Rate this pdoc, posted by Tabitha on March 9, 2003, at 18:54:30
Posted by jay on March 9, 2003, at 19:28:31
In reply to Rate this pdoc, posted by Tabitha on March 9, 2003, at 18:54:30
Yeah, like Ace say's, sometimes we have better luck with GP's. My GP is 1000000000 times smarter, more open than the cranky narrow minded control-freak shrinks I had. I guess it all depends on the luck of the draw. Like Andrew Sololoman(sp?) say's in "Noonday Demon" that "..if you think you are smarter than your pdoc, you likely are!". I can't believe he would put you on Doxepin..ewwwww! Yes my Dad has been on it for years and it helps him, but there are far, far better meds than this. Also, when you do this 'new patient interview', ask HIM/HER about many treatments! It is your chance to interview as well. (Which you did do a bit.)A couple of suggestions:
-With the Celexa, could you not ask for a start with one mood stabalizer? (Just tell him...I WANT to try this!)Some of the latest research even suggests two m.s's may help...such as Lamictal and an older m.s. like Lithium or Depakote.(Don't forget to ask pharmacist about interactions just to be safe.)
-Second, an a.d. add-on for sleep could likely be a small dose of Remeron (would possibly help with aggitation, and any other SRI side effects.) As a second line, maybe Trazadone or Serzone.
-On top of it, if you can until the other meds kick in, a benzo would likely help.
If this guy doesn't seem to have a clue of the above (as you see many of these meds being used as good treatment for others on the board), then dump him and don't settle until you get *the best*. Your goal is as close to 100 Percent symptom reduction as possible, because life is far too short, it is your body, and you are paying for these things. (I.E. through insurance or whatever.)
Let us know how you make out..
Best wishes,
Jay
Posted by KrissyP on March 9, 2003, at 23:13:06
In reply to Rate this pdoc, posted by Tabitha on March 9, 2003, at 18:54:30
WOW-Kudos for you in doing YOUR OWN research on these meds. I'm sorry you had to go through this though-not right. I had the same effect of weight gain when I was on doxepin. "Tetracycline" is for acne-even if he was anywhere near spelling the word correctly.
Oh man. I started back on Lamictal last week and even though (as you may read from some of my posts AND the others) At first I was manic-but I was manic to begin with. I am only at 50mg at night-not nearly a therapeutic dose for mania-and I will slowly increase. IMO, Lamictal does better in COMBO with an SSRI or in my case, the Effexor-I'm just talking from past experience here-I went off both-flipped-and now started back on both over a week ago.
In my opinion, if this guy was recommended by your therapist based on other clients using him, I'd say it is a case of "helping one professional to another professional" whatever professionality is here? Medication therapy IS an experiment, unfortunately-I'm glad you had insurance, (do you have a co-pay?)if not, don't waste your precious energy on them-they'll pay it, that's their job:-) You're more important right now.
**The whole "new patient interview can be humiliating but only if you let it. I understand it's frustrating to have to lay out your whole history-(believe me-I did over 5 times) but any doc needs to know your symptoms to try to help you. Give it a try, but it sounds as if you could do better.
Hope this helped? Hang in, keep us posted k?
Kristen:-)
==================================================================================================he put me on 150mg doxepin as an add-on for insomnia. this is the wrong dose--it's a full antidepressant dose, but I'm bipolar and already on celexa. a sleep add-on dose should be small, maybe only 10mg.
I told him I've had trouble with tricylics before causing pounding heart. he told me doxepin is not a tricyclic, it's a tetracyclic. I looked it up and it's a tricyclic.
he told me doxepin has no side effects except sedation. again, wrong- it's listed at the top for antihistamine effects.
the trial was a disaster. I doubted the 150mg dose so I tried 100mg (this was before I looked up dosing) and it was still the worst med trial ever. I got severe pounding heart, a sick paralyzed panicky feeling, woke up several times in the night with completely dry mouth, overslept by several hours, then the next day felt too groggy to drive, and had the worst food cravings ever. the grogginess and food cravings lasted all day. then I was bloated for days from all the binge eating.
I asked him what he thought of lamictal and he said it was good for mania. Everyone here says it's good for bipolar depression and does nothing for mania.
Am I missing something? how can a pdco be so wrong so many times. This guy was recommended by my therapist based on other clients using him. This is like what you'd expect from a really incompetent GP who doesn't follow psych meds at all.
It's really discouraging. He charged my insurance $200 for this experiment. I've gone to bad pdocs before but they were HMO docs. This guy is private practice. I don't know how to find a competent doctor without wasting time and money like this.
The other thing is I hate the new patient interview. It's so humiliating having to lay out my whole history to a total stranger, having it go into his files, all for nothing.
Posted by KrissyP on March 9, 2003, at 23:19:24
In reply to Re: Rate this pdoc..bzzzzztttt.. » Tabitha, posted by jay on March 9, 2003, at 19:28:31
I agree with this>>"if you think you are smarter than your pdoc, you likely are"! LOl so true.
My GP is a wonderful woman and doc-she has a bedside manner that anyone would want in a doc and she has seen me in good times and bad and still, a great, understanding doc. Yes, sometimes like jay says they work better than "control-freak shrinks" Doxepin is an "old school" med- there does have to be something better-I agree again jay:-) This is YOUR life-not the docs, not your mom's, not the insurance companies. Jay has a lot of good ideas here!
I wish you the best and please keep us posted:-)
Kristen===========================================================================================
> Yeah, like Ace say's, sometimes we have better luck with GP's. My GP is 1000000000 times smarter, more open than the cranky narrow minded control-freak shrinks I had. I guess it all depends on the luck of the draw. Like Andrew Sololoman(sp?) say's in "Noonday Demon" that "..if you think you are smarter than your pdoc, you likely are!". I can't believe he would put you on Doxepin..ewwwww! Yes my Dad has been on it for years and it helps him, but there are far, far better meds than this. Also, when you do this 'new patient interview', ask HIM/HER about many treatments! It is your chance to interview as well. (Which you did do a bit.)
> A couple of suggestions:
>
> -With the Celexa, could you not ask for a start with one mood stabalizer? (Just tell him...I WANT to try this!)Some of the latest research even suggests two m.s's may help...such as Lamictal and an older m.s. like Lithium or Depakote.(Don't forget to ask pharmacist about interactions just to be safe.)
>
> -Second, an a.d. add-on for sleep could likely be a small dose of Remeron (would possibly help with aggitation, and any other SRI side effects.) As a second line, maybe Trazadone or Serzone.
>
> -On top of it, if you can until the other meds kick in, a benzo would likely help.
>
> If this guy doesn't seem to have a clue of the above (as you see many of these meds being used as good treatment for others on the board), then dump him and don't settle until you get *the best*. Your goal is as close to 100 Percent symptom reduction as possible, because life is far too short, it is your body, and you are paying for these things. (I.E. through insurance or whatever.)
>
> Let us know how you make out..
>
> Best wishes,
> Jay
Posted by Tabitha on March 9, 2003, at 23:40:13
In reply to Re: Rate this pdoc..bzzzzztttt.. » jay, posted by KrissyP on March 9, 2003, at 23:19:24
Just keep shopping? I had one that was halfway decent, though he's not on my insurance anymore. I keep falling back on him in between these experiments, for $125 cash per 15 min visit.
It's so frustrating I keep thinking of just trying the do-it-yourself route again with OTC drugs, supplements or illegal mail order pharmacies.
Posted by KrissyP on March 9, 2003, at 23:46:31
In reply to Re: so how do people find good docs?, posted by Tabitha on March 9, 2003, at 23:40:13
time, committment, desire, willingness, and patience:-)
==================================================================================================Just keep shopping? I had one that was halfway decent, though he's not on my insurance anymore. I keep falling back on him in between these experiments, for $125 cash per 15 min visit.
It's so frustrating I keep thinking of just trying the do-it-yourself route again with OTC drugs, supplements or illegal mail order pharmacies.
Posted by ace on March 10, 2003, at 0:42:57
In reply to Rate this pdoc, posted by Tabitha on March 9, 2003, at 18:54:30
Posted by Rainbowlight on March 10, 2003, at 1:29:49
In reply to Rate this pdoc, posted by Tabitha on March 9, 2003, at 18:54:30
Yikes, that rates right up there with some of the worst advice. It is VERY hard to find a good pdoc. Have you asked around on any of the boards to see if maybe there is someone who might be able to suggest a good pdoc in your area? Sometimes it's better to get a referal from patients instead of another doctor. Unfortunately it IS trial and error to find a pdoc that you like.
Posted by Rainee on March 10, 2003, at 5:56:18
In reply to Rate this pdoc, posted by Tabitha on March 9, 2003, at 18:54:30
UGGG! I don't know why most p-docs are such idiots.
I've been to one that yelled at me and told me I woudn't tell him what I wanted to try. I could tell you a bazillion stories of bad docs.
I only had one that was a good doctor and actually cared.
Your not alone!Rainee :)
Posted by laurarn on March 10, 2003, at 10:48:09
In reply to Rate this pdoc, posted by Tabitha on March 9, 2003, at 18:54:30
Hi Tabitha. I am so sorry to hear about your bad experience with that pdoc. Because that is what it was. I can especially relate to having to talk to this doc about your life when you know he is spouting off incorrect information. You also have the dynamic of not really being able to challange this info as you don't want to be labeled "difficult" at your first visit.
I had a similar experience a couple of years ago. In that case I went to my HMO doc and it was a disaster. I then went to another one and it was the best move I ever made. I am still seeing this pdoc and imagine I will until he boots me, which I doubt will happen.
I guess I'm trying to say keep trying, keep looking. Great pdocs are out there. Find one that is OK with you challanging information. I do with mine and it is an important part of what we do. Good luck.
Posted by Dinah on March 10, 2003, at 19:51:32
In reply to Re: so how do people find good docs?, posted by Tabitha on March 9, 2003, at 23:40:13
Heavens, I hate to admit this, but my mother recommended mine. She was telling my sad sad story of my belief that I needed psych meds to everyone who would liesten (as usual) and a lady in her church recommended her psychiatrist as being one that didn't push meds. Funny thing is that he'a a psychopharmacologist. LOL. He could see me sooner than any of the others because I had a source of referral and I just plain liked him. Very low key and educated. Admits to the downside of meds. His favorite phrase is that there are side effects to taking meds, and side effects to not taking them, and it's up to me to choose which side effects I prefer.
So, do you have indiscreet family members or friends to ask for referrals for you if you're too embarassed to do it yourself?
Posted by Eggy on March 10, 2003, at 19:59:25
In reply to Rate this pdoc, posted by Tabitha on March 9, 2003, at 18:54:30
I know how frustrating it is to find a good Dr. And then not only to find a good one but then to feel comfortable with them. I am lucky to have a good one now. Have you called your insurance company and asked them the most used Dr. in your area. This is how I found mine. I had to wait a while to see him but it was worth it. As for the Lamictal...I was on Lamictal...I did absolutely great on it...but I quit it because I thought it was making me gain weight. But it wasn't the Lamictal. I think it is the Seroquel. But I am on a high dose. I was on Lamictal for Borderline personality disorder. I am also Bi-polar and I never did go Manic while on Lamictal, my moods were very stable. If a doctor doesn't listen to you when you tell him something, especially concerning side-effects from drugs, you need to set him straight or find another doc. Sometimes it works to simply tell them how it is...for instance "Listen here...I told you this med made my heart rhythm irregular and you didn't listen. If you respect me as a patient then we need to work together; otherwise I will be looking for another Dr." Ive done it before...but I have a bad attitude and my doc was use to my smart mouth. Good Luck!!
Posted by viridis on March 10, 2003, at 22:20:09
In reply to Re: so how do people find good docs? » Tabitha, posted by Dinah on March 10, 2003, at 19:51:32
I got lucky. When I asked my GP for a referral to a psychiatrist, he said that my problems were "imaginary" and he didn't know of any psychiatrists (interesting, since I live in a large metropolitan area, have good insurance, and as it turns out, the psychiatrist I found is good friends with my GP and has an office a few blocks away).
So, I went down the list of psychiatrists on my plan, made a series of appointments, and decided I'd just try each. The first one I saw has a small, low-key offfice about 10 minutes from my house, was very professional yet compassionate, and spent well over an hour with me. When I described my reactions to various ADs etc., he said yes, that's no surprise. Essentially, he told me that in his opinion, most of the meds I'd tried were totally inappropriate for my situation and would be his last choices. He initially prescribed benzos (I have serious anxiety problems), and when I expressed concern about "addiction" etc., he sympathized but encouraged me to try them, with the warning that there was a high probability I'd become dependent, and that he'd be very vigilant about any misuse or dosage escalation. But he also said that this was pretty standard, and generally fairly easy to deal with if they're used appropriately. The relief from anxiety and depression was immediate.
Since then, I've improved tremendously, and we've arrived at an effective combination with lots of input on my side. I actually enjoy my visits, because he treats me with respect and listens to what I say. And, several people have since said things like "wow, you're lucky to be seeing Dr. so-and-so -- I'm trying to get in to see him, because the therapists recommend him so highly".
This sounds great, but the fact is, he's the first doctor (psych or otherwise) I've seen in 12 years whom I really trust. And, if we hadn't clicked, I would have gone to the various other appointments until I found someone I could work with (instead, I cancelled them). So, in a sense, I got lucky, but only in this round -- I was determined enough, after years of failures, to keep searching until I found the right person, and now I think I have.
Now I just have to worry about him retiring -- but at least I can trust him to recommend someone else reasonable when this happens. And, I recommend him to others, so if you're in a position to ask around, I would; good pdocs get good reputations. As I mentioned, the local therapists also seem to think highly of him, so this might be another place to start.
Good luck!
Posted by KrissyP on March 11, 2003, at 0:33:24
In reply to Re: so how do people find good docs? » Tabitha, posted by Dinah on March 10, 2003, at 19:51:32
Hey, and all the better>>>"His favorite phrase is that there are side effects to taking meds, and side effects to not taking them, and it's up to me to choose which side effects I prefer".
Dinah-it may not be a case of embarrassment for her?
Just a thought what do you think?
==================================================================================================
> Heavens, I hate to admit this, but my mother recommended mine. She was telling my sad sad story of my belief that I needed psych meds to everyone who would liesten (as usual) and a lady in her church recommended her psychiatrist as being one that didn't push meds. Funny thing is that he'a a psychopharmacologist. LOL. He could see me sooner than any of the others because I had a source of referral and I just plain liked him. Very low key and educated. Admits to the downside of meds. His favorite phrase is that there are side effects to taking meds, and side effects to not taking them, and it's up to me to choose which side effects I prefer.
>
> So, do you have indiscreet family members or friends to ask for referrals for you if you're too embarassed to do it yourself?
Posted by KrissyP on March 11, 2003, at 0:45:10
In reply to Re: Rate this pdoc » Tabitha, posted by Eggy on March 10, 2003, at 19:59:25
Hi, can I please ask you something about this>>>"As for the Lamictal...I was on Lamictal...I did absolutely great on it...but I quit it because I thought it was making me gain weight. But it wasn't the Lamictal. I think it is the Seroquel. But I am on a high dose. I was on Lamictal for Borderline personality disorder. I am also Bi-polar and I never did go Manic while on Lamictal, my moods were very stable".
I'm on both meds just started 75mg Lamictal now, and I take 100mg Seroquel. I have been labeled as having BPD tendencies but not full-blown
can you tell me how many mg you are on of your meds please?
Thanks so much-it would help.
Kristen
================================================================================================== > I know how frustrating it is to find a good Dr. And then not only to find a good one but then to feel comfortable with them. I am lucky to have a good one now. Have you called your insurance company and asked them the most used Dr. in your area. This is how I found mine. I had to wait a while to see him but it was worth it. As for the Lamictal...I was on Lamictal...I did absolutely great on it...but I quit it because I thought it was making me gain weight. But it wasn't the Lamictal. I think it is the Seroquel. But I am on a high dose. I was on Lamictal for Borderline personality disorder. I am also Bi-polar and I never did go Manic while on Lamictal, my moods were very stable. If a doctor doesn't listen to you when you tell him something, especially concerning side-effects from drugs, you need to set him straight or find another doc. Sometimes it works to simply tell them how it is...for instance "Listen here...I told you this med made my heart rhythm irregular and you didn't listen. If you respect me as a patient then we need to work together; otherwise I will be looking for another Dr." Ive done it before...but I have a bad attitude and my doc was use to my smart mouth. Good Luck!!
Posted by Dinah on March 11, 2003, at 7:28:46
In reply to Re: so how do people find good docs? » Dinah, posted by KrissyP on March 11, 2003, at 0:33:24
Hey, Krissy.
I was just being playful.
I've never been particularly embarassed either. Bue neither do I go around asking perfect strangers about my mental health. It bugs me to death that my mother does, but in this case it worked out for the best. Hence the humor.
Posted by Krissy P on March 11, 2003, at 13:55:28
In reply to Re: so how do people find good docs? » KrissyP, posted by Dinah on March 11, 2003, at 7:28:46
*smile* LOL I hear ya.
I laughed at the fact you don't go ask strangers about your mental helath. Why???
(Just joking!!!!)
LOL man if I did that, I'd be a hell of a lot worse off. Hope you're doing good:-)
Kristen
==================================================================================================
Hey, Krissy.
I was just being playful.
I've never been particularly embarassed either. Bue neither do I go around asking perfect strangers about my mental health. It bugs me to death that my mother does, but in this case it worked out for the best. Hence the humor.
Posted by Eggy on March 11, 2003, at 14:35:46
In reply to Re: Rate this pdoc » Eggy, posted by KrissyP on March 11, 2003, at 0:45:10
I almost passed up your message because it sounded so much like I wrote it. Sure here is all the meds I am on...including non "mental" drugs...
Seroquel...150mg
Topamax...100mg...love this stuff
Vistaril...50mg...for sleep
Lexapro...50mg
Ambien...10mg
Synthroid...0.15
Zantac...150mg
Ativan...0.10
My Lamictal was up to 100 mg when I quit it. I shouldn't have though. I was back to good old happy me. It took about 6 months but I was back to finger painting witht the kids and even actually listening to my mom and pretending or maybe actually enjoying it. I may go back on it. I am just so stubborn. My poor Pdoc goes through Hell with me quitting and changing meds. It may kill him if I admit he was right about something. Let me know if you need something else.
Posted by Krissy P on March 11, 2003, at 15:18:06
In reply to Re: Rate this pdoc » KrissyP, posted by Eggy on March 11, 2003, at 14:35:46
Thanks for replying.
I am such a believer in Lamictal it has stabilized me so much in the past (I went off and started again 2 weeks ago), that I feel almost better than my "normal" state.Topamax...100mg...love this stuff-Why?
You are on Synthroid, do you remember what your thyroid levels were? I have gotten my thyroid tested many times-LOW-but never any recommendation of Synthroid-I wonder if it would help this weight considering my thyroid levels were in the low range???
What do you think?
Take it easy, Kristen:-)
==================================================================================================I almost passed up your message because it sounded so much like I wrote it. Sure here is all the meds I am on...including non "mental" drugs...
> Seroquel...150mg
> Topamax...100mg...love this stuff
> Vistaril...50mg...for sleep
> Lexapro...50mg
> Ambien...10mg
> Synthroid...0.15
> Zantac...150mg
> Ativan...0.10
>
>
> My Lamictal was up to 100 mg when I quit it. I shouldn't have though. I was back to good old happy me. It took about 6 months but I was back to finger painting witht the kids and even actually listening to my mom and pretending or maybe actually enjoying it. I may go back on it. I am just so stubborn. My poor Pdoc goes through Hell with me quitting and changing meds. It may kill him if I admit he was right about something. Let me know if you need something else.
Posted by Eggy on March 11, 2003, at 20:22:39
In reply to Re: Rate this pdoc » Eggy, posted by Krissy P on March 11, 2003, at 15:18:06
You know...I never did know my thyroid level. I have been on Synthroid since I was a teen. And it's been under control since then with the Synthroid. Unless your on a dose high enough to overact your thyroid it probably will not make you lose weight. It sure hasn't made me lose weight. I can honestly say I have never been on an anti-depressant that hasn't made me gain some weight. But I suppose it is worth it. The only medicines I will NEVER take again are Celexa and Sonata...we just did not get along.
This is the end of the thread.
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