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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 10 to 34 of 34. Go back in thread:
Posted by Smallchange on March 21, 2003, at 0:27:02
In reply to Perfect example of psychiatric arrogance., posted by Questionmark on March 20, 2003, at 18:03:19
I have had lousy docs too. But keep searching. After lots of sucky ones, I have found the doctor of my dreams. He ALWAYS listens to me and even asks me what I think. He knows that I am in tune with my body and that I watch carefully for what works and what doesn't. He is just so awesome and he is always willing to try something new if what I am on is not working. There are good doctors out there, just keep searching.
Posted by glenn on March 21, 2003, at 5:04:36
In reply to Re: Perfect example of psychiatric arrogance., posted by Smallchange on March 21, 2003, at 0:27:02
That's some docs for you I am afraid, one I saw a few years ago wrote in his notes:" Glenn is a difficult patient, if I tell him anything he goes away and reads about it!"
Wierd aren't I ?Glenn
ps I don't see him anymore, my current one is just like that described in the previous post!
Posted by falconman on March 21, 2003, at 6:56:38
In reply to Perfect example of psychiatric arrogance., posted by Questionmark on March 20, 2003, at 18:03:19
Give me the internet and a drug store and I'll treat myself better and faster than any pdoc could. Its a shame there are so many people going through pdoc school that haven't an ounce of logic. In short most of them suck big time!!
Posted by zippy on March 21, 2003, at 14:28:23
In reply to Klonopin- more articulate on it!, posted by utopizen on March 20, 2003, at 15:29:59
Utopizen,
You responded to my earlier email as if I were responding to your email. If you go back and look at it, I was addressing it to "Questionmark". I thought your email was very thoughtful, and it does sound like your pdoc has an unreasonable orientation. I'd find another if I were in your shoes.
Posted by stjames on March 21, 2003, at 14:54:21
In reply to Klonopin- more articulate on it!, posted by utopizen on March 20, 2003, at 15:29:59
You have posted several time about problems with
your doc. It does seem he/she is not al all good for you. This begs the question, why do you stay, and pay ?
Posted by utopizen on March 21, 2003, at 16:04:38
In reply to Why do you continue with this doc ?, posted by stjames on March 21, 2003, at 14:54:21
> You have posted several time about problems with
> your doc. It does seem he/she is not al all good for you. This begs the question, why do you stay, and pay ?I've called a dozen docs already, and they all want to hang up the phone when I tell them what meds I've been on (I've tried a lot, from ADs to APs).
I told this to my doc, so he's called a person that will see if she can schedule something so I can switch to his colleague. I'm in the position right now where it's best to have him take things over with switching me to another doc, because the hospital I want to use as an outpatient requires that my doctor arrange the switch for "conflict of interest" purposes.
Posted by Krissy P on March 21, 2003, at 22:11:47
In reply to Klonopin- more articulate on it!, posted by utopizen on March 20, 2003, at 15:29:59
Hi, good for you, glad you told your doc this>> I don't view Klonopin as a smart drug. I just think I get so much anxiety, the removal of this anxiety lets me think in a way that I would otherwise already think without the anxiety present.
I agree, I take 2mg of Klonopin-but lately have been taking extra PRN. It helps me think more clearly too, but what doesn't is the Seroquel I take. I also had ECT and my brain has never felt the same. I'm already blonde and really do feel like a dumb blonde sometines LOL
Take care:-)
kristen
--------------------------------------------------------------------------------------------------> So I told me p-doc the other day I was more articulate when I took Klonopin. When I give a presentation on it, I sound more articulate than ever, look directly at people, barely need my notecards, words seem to come out freely with no effort. And people have this "wow" feeling about what I say. Very impressive.
>
> Well, I told this to my pdoc, and he said it was "irrational" to think this way. But I told him, I don't view Klonopin as a smart drug. I just think I get so much anxiety, the removal of this anxiety lets me think in a way that I would otherwise already think without the anxiety present.
>
> Well, he seemed more convinced, but still didn't admit it was "rational."
>
> I stopped listening to this doc a long time ago, but when he says things like this I look things up to confirm my hypothesis that he dismissed and find things that support it.
>
> Well guess where I find it? In the TEXTBOOK OF PSYCHOPHARMACOLOGY, the very book he just bought and sat on his desk. !!!!
>
> It said under benzos (side effects and toxicology):
>
> "Although normal subjects clearly show mental impairment with the benzodiazepines, the situation with anxious patients is more complex. Because anxiety itself interferes with mental performance, alleviation of the anxiety may result in improved functioning that more than compensates for the direct drug-related decrement. The effect in some patients may be complicatied and unpredictable, even at low dosages."
>
>
> The American Psychiatric Press Textbook of Psychopharmacology, p.414
>
>
> I was SHOCKED to read this, because it almost paraphrases what I explained to my doc- that I was aware it is a dumb drug to most people, but in my case the anxiety makes me so dumb that the relief from the anxiety makes me smarter.
Posted by Krissy P on March 21, 2003, at 22:13:34
In reply to Re: Klonopin- more articulate on it! » utopizen, posted by Ritch on March 20, 2003, at 21:15:38
Posted by Krissy P on March 21, 2003, at 22:17:43
In reply to Re: Klonopin- more articulate on it! » utopizen, posted by viridis on March 20, 2003, at 22:17:49
HI again, yes, you sound quite rational to me too, I agree here too that it is a shame that so many people have to argue with their doctors, ESPECIALLY justify their refusal to take certain meds, and practically beg for appropriate treatment. I also went through that for years.
I wonder too if docs are more motivated by the profits/gifts associated with still-under-patent-drugs, and wowed by the sales pitches of pharmaceutical reps, are afraid of being hassled for prescribing so-called "addictive" drugs, or what? I can't say enough how well Klonopin does for my anxiety-it just calms my ass down quite well:-)
All the best, Kristen:-)
--------------------------------------------------------------------------------------------------I'm not trying to bash the pharm companies or deny that the newer meds can be great for some people, but if they don't work, why is there such reluctance to go back to the old standards?I'm definitely more clear-headed with Klonopin than without. Previously, when I had my regular (and frequent) episodes of anxiety, it interfered with my thinking, interactions with others, motivation, etc., and inevitably led to periods of intense, agitated depression. So, I was hardly articulate (or even functional) a fair bit of the time.
With K, things aren't perfect, but they're vastly better. Plus, I don't have to deal with all the weird side effects of the various ADs etc.
I just had my usual 3-month visit with my pdoc. We chatted, he asked if I was experiencing any side effects, tolerance, etc. (the answer is no) and he wrote out my regular 90-day prescription of K, Xanax, Adderall, and Neurontin.
It all seemed so civilized. It's a shame that so many people have to argue with their doctors, justify their refusal to take certain meds, and practically beg for appropriate treatment. I went through that for years, and I really have to wonder if many docs/pdocs are just clueless, are motivated by the profits/gifts associated with still-under-patent-drugs, are wowed by the sales pitches of pharmaceutical reps, are afraid of being hassled for prescribing so-called "addictive" drugs, or what?
I'm not trying to bash the pharm companies or deny that the newer meds can be great for some people, but if they don't work, why is there such reluctance to go back to the old standards?
As for "rationality", I posted about that above -- you sound quite rational to me.
Posted by Krissy P on March 21, 2003, at 22:22:08
In reply to Re: Perfect example of psychiatric arrogance., posted by zippy on March 20, 2003, at 22:27:35
zippy, you say here: "I don't feel a need to control patients, nor will I allow them to control me"-well, you forgot one VERY IMPORTANT thing that you didn't even mention in your post. DOCS AND PATIENTS NEED TO WORK AS A TEAM TOO!!!!!!!!!!!!!!!! I am a patient that will not allow a doc to control me and it may be your license but it's MY body, did you remember that when you took the oath of FIRST DO NO HARM???
Excuse me for saying, but you seem a little like one of the arrogant docs and you just proved it by your post. Do you really even get it?
Regards.........--------------------------------------------------------------------------------------------------
> Questionmark:
> Your blanket appraisals of doctors is the very reason we as physicians need to be careful in our treatment practices. I try to encourage the patients whom I see to make their own decisions based on the information I give them. However, I have limits in terms of what treatments I'm comfortable providing. You may call that "arrogance", and you're entitled to that opinion. Notwithstanding, if I come across disagreements with my patients, I'll be the first to admit that the relationship will likely not move forward, and advise them to get another opinion. I don't feel a need to control patients, nor will I allow them to control me, whether or not the treatment considerations include controlled substances. Yes, it's your body, but it's my license! I've been a patient too for treatment of a serious illness, and having been on both sides of the fence, I appreciate the anxieties that patients and doctors face in their relationships with one another. The most important point here is to find a doctor whom you trust, and you'll be more comfortable with your health care. If you really believe that all doctors are @$!!&**%'s, then you may need to take a look inside to see what role you play in the failures of your treatment experiences.
Posted by Krissy P on March 21, 2003, at 22:23:44
In reply to Re: Perfect example of psychiatric arrogance., posted by Smallchange on March 21, 2003, at 0:27:02
Posted by Krissy P on March 21, 2003, at 22:26:20
In reply to Re: Perfect example of psychiatric arrogance., posted by glenn on March 21, 2003, at 5:04:36
Any doc that tells you you are a difficult patient oughta be shot-that is WRONG! Who do some of these docs think they are? I hate to hear other people having gone through this. NOT all docs are great-PERIOD
So happy to hear that you are seeing a great one now-you don't need that, and docs should think
about what they say sometimes to their patients-their job depends on it.Take care, Kristen:-)
--------------------------------------------------------------------------------------------------
> That's some docs for you I am afraid, one I saw a few years ago wrote in his notes:" Glenn is a difficult patient, if I tell him anything he goes away and reads about it!"
> Wierd aren't I ?
>
> Glenn
> ps I don't see him anymore, my current one is just like that described in the previous post!
Posted by Krissy P on March 21, 2003, at 22:43:24
In reply to Klonopin- more articulate on it!, posted by utopizen on March 20, 2003, at 15:29:59
Posted by Krissy P on March 21, 2003, at 22:44:12
In reply to Re: Why do you continue with this doc ?, posted by utopizen on March 21, 2003, at 16:04:38
Posted by falconman on March 22, 2003, at 0:20:50
In reply to Re: Perfect example of psychiatric arrogance., posted by zippy on March 20, 2003, at 22:27:35
hi,
i appologise for my statement which suggested that most pdocs are incompitant. I have had a rough experiece with several pdocs in which i perceived their manner to be particulary unproffesinal and led to a anything but theraputic relations.However i am aware that i should not express my bitterness on this board, in which so many people offer such great support and understandingThere are good pdocs out there and I suppose I have just had a run of bad luck.
I particulary I apologise to zippy as he/she stated being in the proffesion of psychiatry, and taking part in posts of this nature proves that he/she takes a more attive role in understanding patients. If only there were more docs like this!!
zippy you deserve respect and I hope my earlier post did not offend you.I also take on board your comment about looking inside to gain insight into why treatment has failed so many times with several pdocs.
Regards
Falcon
Posted by Ted1962 on March 23, 2003, at 12:18:48
In reply to Re: Klonopin- more articulate on it! » utopizen, posted by viridis on March 20, 2003, at 22:17:49
> I'm definitely more clear-headed with Klonopin than without. Previously, when I had my regular (and frequent) episodes of anxiety, it interfered with my thinking, interactions with others, motivation, etc., and inevitably led to periods of intense, agitated depression. So, I was hardly articulate (or even functional) a fair bit of the time.
>
> With K, things aren't perfect, but they're vastly better. Plus, I don't have to deal with all the weird side effects of the various ADs etc.
>
> I just had my usual 3-month visit with my pdoc. We chatted, he asked if I was experiencing any side effects, tolerance, etc. (the answer is no) and he wrote out my regular 90-day prescription of K, Xanax, Adderall, and Neurontin.
>
> It all seemed so civilized. It's a shame that so many people have to argue with their doctors, justify their refusal to take certain meds, and practically beg for appropriate treatment. I went through that for years, and I really have to wonder if many docs/pdocs are just clueless, are motivated by the profits/gifts associated with still-under-patent-drugs, are wowed by the sales pitches of pharmaceutical reps, are afraid of being hassled for prescribing so-called "addictive" drugs, or what?
>
> I'm not trying to bash the pharm companies or deny that the newer meds can be great for some people, but if they don't work, why is there such reluctance to go back to the old standards?
>
> As for "rationality", I posted about that above -- you sound quite rational to me.> You mentioned in your posting that you take Klonopin and Xanax, along with adderall and Neurontin. How are you dosing the Klonopin and Xanax each day? I think the combination makes great sense.
Posted by Dr. Bob on March 23, 2003, at 18:34:18
In reply to Re: Perfect example of psychiatric arrogance. » zippy, posted by Krissy P on March 21, 2003, at 22:22:08
> DOCS AND PATIENTS NEED TO WORK AS A TEAM TOO!!!!!!!!!!!!!!!!
That's a good point.
> Excuse me for saying, but you seem a little like one of the arrogant docs and you just proved it by your post. Do you really even get it?
But please don't post anything that could lead others to feel accused or put down, thanks.
Bob
PS: Follow-ups regarding posting policies should be redirected to Psycho-Babble Administration; otherwise, they may be deleted.
Posted by Viridis on March 23, 2003, at 23:09:51
In reply to Re: Klonopin- more articulate on it!, posted by Ted1962 on March 23, 2003, at 12:18:48
Hi Ted,
I take 1 mg Klonopin in the morning (together with 5 mg Adderall and 400 mg Neurontin), then usually take 5 mg more Adderall a few hours later, and 400 mg Neurontin twice more during the day.
I just take Xanax whenever I feel it necessary -- my pills are 0.25 mg (very low dose). I may go without it for 1-2 weeks, then take it 2 or 3 days in the next week. I take 0.25 mg before stressful meetings, and occasionally up to 1 mg after a very intense day (this much makes me very sleepy). It's a great drug, and I use it as needed, very sporadically.
My pdoc is totally comfortable with my pattern of use. Now that it's clear that I won't abuse it, he says just take it whenever you need to. I've never noticed any interaction with my other meds, and it's self-limiting in that anything over 0.5 mg makes me drowsy. My use probably averages 1-2 mg/week, and I have a vast supply of extra pills, which is a great safety net in case I ever have another episode of agitated depression.
The best thing about Xanax (for me) is that it acts fast and really shuts down anxiety and negative thoughts. I use it pretty much the way many people use aspirin for headaches -- I take it when I need it, but have no desire to do so otherwise.
Posted by Ted1962 on March 23, 2003, at 23:37:23
In reply to Re: Klonopin- more articulate on it! » Ted1962, posted by Viridis on March 23, 2003, at 23:09:51
> Hi Ted,
>
> I take 1 mg Klonopin in the morning (together with 5 mg Adderall and 400 mg Neurontin), then usually take 5 mg more Adderall a few hours later, and 400 mg Neurontin twice more during the day.
>
> I just take Xanax whenever I feel it necessary -- my pills are 0.25 mg (very low dose). I may go without it for 1-2 weeks, then take it 2 or 3 days in the next week. I take 0.25 mg before stressful meetings, and occasionally up to 1 mg after a very intense day (this much makes me very sleepy). It's a great drug, and I use it as needed, very sporadically.
>
> My pdoc is totally comfortable with my pattern of use. Now that it's clear that I won't abuse it, he says just take it whenever you need to. I've never noticed any interaction with my other meds, and it's self-limiting in that anything over 0.5 mg makes me drowsy. My use probably averages 1-2 mg/week, and I have a vast supply of extra pills, which is a great safety net in case I ever have another episode of agitated depression.
>
> The best thing about Xanax (for me) is that it acts fast and really shuts down anxiety and negative thoughts. I use it pretty much the way many people use aspirin for headaches -- I take it when I need it, but have no desire to do so otherwise.
> Viridis, thanks for your information. I really appreciate it. I recently went back on Klonopin, in order to get off the Xanax and be able to get smoother control for the anxiety. But I am finding that I still need to take about a .5mg of Xanax a day. I also take 200mgs of Wellbutrin Sr a day. I don't know if my doc will want me to continue to supplement the Klonopin, or just have me go back on Xanax, which would then require that I go back up to 1.5 to 2 mgs a day. If you don't mind me asking, what do you suffer from or where does your diagnosis fall? Thanks....Ted
Posted by Krissy P on March 24, 2003, at 0:24:57
In reply to Re: please be civil » Krissy P, posted by Dr. Bob on March 23, 2003, at 18:34:18
Bob, I posted to you at Psycho-Babble Administration. I am so sorry-I shouldn't have lashed out in the heat of the moment. I have had a few bad experiences with docs buit the poster didn't deserv this-especially my caps.
I am really sorry :-(
as I slap my face.
> > DOCS AND PATIENTS NEED TO WORK AS A TEAM TOO!!!!!!!!!!!!!!!!
>
> That's a good point.
>
> > Excuse me for saying, but you seem a little like one of the arrogant docs and you just proved it by your post. Do you really even get it?
>
> But please don't post anything that could lead others to feel accused or put down, thanks.
>
> Bob
>
> PS: Follow-ups regarding posting policies should be redirected to Psycho-Babble Administration; otherwise, they may be deleted.
Posted by Krissy P on March 24, 2003, at 0:37:52
In reply to Re: Perfect example of psychiatric arrogance. » zippy, posted by Krissy P on March 21, 2003, at 22:22:08
I sincerely apologize. I acted in the heat of the moment and you didn't deserve that. I have had a few bad experiences with docs. I should have not directed my issues at you.
I'm really sorry.
Can you forgive me?
kristen
Posted by Viridis on March 24, 2003, at 0:44:17
In reply to Re: Klonopin- more articulate on it!, posted by Ted1962 on March 23, 2003, at 23:37:23
Well, my "official" diagnosis is panic disorder, ADD, and major depressive disorder. I'm sure some pdocs would diagnose me as bipolar 2, but I don't quite fit the profile, since I never get really manic, although probably hypomanic sometimes.
My psychiatrist is quite insistent that I stay on mood stabilizers; he considers Klonopin a pretty good one, and Neurontin a very mild stabilizer. He asked me once to try Depakote, but I refused, and he hasn't pushed it since I'm doing well on my current regimen.
If you have anxiety problems, I'd be careful with Wellbutrin -- it can be very anxiogenic (was for me), although it's a good AD for some people. The Klonopin/Xanax mix is a good one, and Xanax in particular can have antidepressant effects. If it works for you, I'd stick with it. So much of this is trial and error, and when you find a combo that's effective, I wouldn't mess with it.
Posted by Ted1962 on March 24, 2003, at 14:07:44
In reply to Re: Klonopin- more articulate on it! » Ted1962, posted by Viridis on March 24, 2003, at 0:44:17
> Well, my "official" diagnosis is panic disorder, ADD, and major depressive disorder. I'm sure some pdocs would diagnose me as bipolar 2, but I don't quite fit the profile, since I never get really manic, although probably hypomanic sometimes.
>
> My psychiatrist is quite insistent that I stay on mood stabilizers; he considers Klonopin a pretty good one, and Neurontin a very mild stabilizer. He asked me once to try Depakote, but I refused, and he hasn't pushed it since I'm doing well on my current regimen.
>
> If you have anxiety problems, I'd be careful with Wellbutrin -- it can be very anxiogenic (was for me), although it's a good AD for some people. The Klonopin/Xanax mix is a good one, and Xanax in particular can have antidepressant effects. If it works for you, I'd stick with it. So much of this is trial and error, and when you find a combo that's effective, I wouldn't mess with it.> That is interesting. I have been worked up for ADD and possible Bipolar 2 as well, but the only defintive conditions that the doc is working with is rather severe GAD with some breakthrough panic attacks, and Depression. I hear what you are saying about the Wellbutrin. This is why I don't go any higher than 200mgs/day. I just have not been able to stay with any other AD long enough, either because of side effects, and or lack of efficacy.....Ted
Posted by Viridis on March 24, 2003, at 14:36:24
In reply to Re: Klonopin- more articulate on it!, posted by Ted1962 on March 24, 2003, at 14:07:44
Hi Ted,
You sound pretty similar to me. One thing I plan to try (when my life isn't quite so hectic) is Strattera (atomoxetine). You've probably seen all the discussion here about it -- it's a selective norepinephrine reuptake inhibitor that's being marketed for ADD but also has strong AD properties for some people. My pdoc is quite enthusiastic about it, and eager for me to try it.
However, I do find Adderall very useful for both ADD and depression, and not at all anxiety-provoking like WB was. So, if Strattera fails, I'll stay with Adderall. I seem to do well on a very low dose (5 mg 2X/day) and haven't developed any tolerance after over a year.
In any case, I'll also stay with the benzos, because they've worked wonders for anxiety and anxiety-related depression. I seem to have two distinct kinds of depression. One is very agitated, involving obsession with very specific problems, insomnia, loss of appetite, etc. This is the most serious, and the benzos are extremely effective for this. But with benzos alone, I still experience periods of more apathetic/lethargic depression, feeling hopeless etc. It comes and goes, and I'm quite sure it's not caused by benzos, since I've experienced this episodically for as long as I can remember. Adderall keeps this at bay, while helping me concentrate more effectively.
I'm a little skeptical about the "BP 2" thing. I'm sure there's something to it, but my impression is that a lot of people with complex disorders seem to get shunted into this category, which can limit use of certain meds that could be very useful (like stimulants).
Good luck!
Viridis
Posted by Questionmark on March 24, 2003, at 23:21:35
In reply to Re: Perfect example of psychiatric arrogance., posted by zippy on March 20, 2003, at 22:27:35
> Questionmark:
> Your blanket appraisals of doctors is the very reason we as physicians need to be careful in our treatment practices. I try to encourage the patients whom I see to make their own decisions based on the information I give them. However, I have limits in terms of what treatments I'm comfortable providing. You may call that "arrogance", and you're entitled to that opinion. Notwithstanding, if I come across disagreements with my patients, I'll be the first to admit that the relationship will likely not move forward, and advise them to get another opinion. I don't feel a need to control patients, nor will I allow them to control me, whether or not the treatment considerations include controlled substances. Yes, it's your body, but it's my license! I've been a patient too for treatment of a serious illness, and having been on both sides of the fence, I appreciate the anxieties that patients and doctors face in their relationships with one another. The most important point here is to find a doctor whom you trust, and you'll be more comfortable with your health care. If you really believe that all doctors are @$!!&**%'s, then you may need to take a look inside to see what role you play in the failures of your treatment experiences.Zippy, you seem like a good doctor, and i know there are good (and sincerely concerned, etc.) drs. and psychiatrists out there. If you look at my post more clearly, however, you will see that i never made any blanket statements about "all doctors." i specifically said "some psychiatrists". It's so annoying when people generalize/exaggerate something i say and/or put words in my mouth like that-- but, no big deal, we all do it sometimes, and i know you probably just misunderstood. Anyway, keep up the good work.
Yes, many docs are great; many are terrible though, too.
This is the end of the thread.
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